Recent orders
ACCOUNTABLE CARE ORGANIZATION
ACCOUNTABLE CARE ORGANIZATION
Integrated health care association (IHA) is a national wide health organization that provides quality, improvement and accountability health care in California. IHA is a non-profit organization that has a mission to assemble other heath care organization to collaborate on health care issues. The association conducts regional and statewide programs that help to assist in promoting health care programs and projects.
P4P
Health care pay for performance rewards physicians, hospitals and providers with money and non-financial strategies based on their performance (Berenson, 2010). The financial aspects cover various issues such as quality of clinic, adoption of technology and experience of patients. The sponsors of payment of performance are government agencies, insurance plans and health care providers. Most of Payment for performance programs have demonstrated improvement of clinical quality and have encouraged health providers to use systems of clinical health. P4P programs that have encouraged use of efficiency and quality services have experienced the advantage of cost savings. In addition, P4P services have shown improvements in patients’ experience. However, there are inevitable consequences that arise because of P4P. These include avoidance of complains from patients and handling patients with more than one health condition. However, there is no evidence on the above complains.
Research has shown that P4P programs have initiated change in behavior and have engaged provides. This program has assisted in follow up of patients conditions and has encouraged providers to adopt technology in health care. The program has also encouraged providers in improvement of health care services and collaborative learning has reduced unwanted practices.
There are new medical devices that have assisted in health care improvement and reduced death rates. However, these devices have also increased cost in healthcare (Berenson, 2010). These new medical services that are used and specialty of procedures used add quality to the hospital and services provided by the medical practioners. They also encourage adoption of health care technology and improvement of heath care insurance plans. Quality and efficiency is marked by better data collection and high standard benchmark on the prices of equipment both locally and internationally. In addition, there in improved purchasing of hospital equipment with the collaboration of physicians and provision of best services in the hospital. Lastly, there is advanced methods of payments where the incentives of the physicians and hospitals are bundled together.
Episode Payment
There is growing interest world wide in method of medical care treatment in connection to heath care policies. There are proposes on whether payment should be done on basis of episode care instead of the individual test or population based care (Kocher &Sahni, 2010). Coming up with a single budget of free care that involves many providers might bring quality and efficiency problems in connection to the current payment method. This is because there is increased imbursement and increased services that need payment. Pricing methods that involves bundling of various components of services might bring issues of transparency to the consumers. It is therefore important for the teams to make informed choices on selection of the provider team. IHA is conducting bundling payment of the services offered in California. This demonstration begun with bundling payment for knee and hipbone replacement.
Efficiency Measurement
There is a national wide campaign in private and government-sponsored hospitals in measurement of efficiency and increasing transparency in use of resources and cost of medical services. This will improve the quality of medical services and enhance improvement in health care. California stakeholders have an opportunity to adopt standardized measures and ensure there is efficiency development by using a collaborative report (Lee, Casalino, Fisher, 2010). Using standardized procedures and transparency in the cost is a method of creating a balanced and fair comparison on the physician group in connection to P4P. Even though measurement of efficiency and transparency might result to apprehension to those who are measured, it is good strategy for ensuring affordability in health care programs. The main goal of P4P efficiency measurement program is for lowering medical cost without compromising the quality of medical health care. This can be achieved through the development of a reliable and valid set of efficiency measures and establishing a trusted process of data collection and analysis. In addition, it is convenient to collaborate with other heath care plans for provision of meaningful incentives for provision of efficient health care delivery.
Conclusion
Integrated health care association (IHA) is a national wide health organization that provides quality, improvement and accountability health care in California. Health care pay for performance rewards physicians, hospitals and providers with money and non-financial strategies based on their performance. Research has shown that P4P programs have initiated change in behavior and have engaged provides. There are new medical devices that have assisted in health care improvement and reduced death rates. However, these devices have also increased cost in healthcare. There is growing interest world wide in method of medical care treatment in connection to heath care policies. There is a national wide campaign in private and government-sponsored hospitals in measurement of efficiency and increasing transparency in use of resources and cost of medical services.
References
Berenson, R. A. (2010). Shared Savings Program for Accountable Care Organizations: A Bridge to Nowhere? American Journal of Managed Care, 16 (10), 721-726. Retrieved on March 2013 from,
<http://www.ajmc.com/media/pdf/AJMC_10oct_Berenson_721to726.pdf>
Kocher R. &Sahni N. R. (2010).Physicians versus Hospitals as Leaders of Accountable Care Organizations. New England Journal of Medicine, 363(27), 2579-2582. Retrieved on March 25 2013 from,
<http://www.nejm.org/doi/pdf/10.1056/NEJMp1011712>
Lee, T. H., Casalino, L. P., Fisher, E. S. &Wilensky, G. R. (2010).Creating Accountable Care Organizations.New England Journal of Medicine, 363 (15), e23. Retrieved on March 25 2013 from,
<http://www.nejm.org/doi/full/10.1056/NEJMp1009040 (video) or http://www.nejm.org/doi/media/10.1056/NEJMp1009040/NEJMp1009040.pdf>
Capital punishment in the USA
Name
Professor
Course
Date
Capital punishment in the USA
Introduction
Capital punishment refers to the legal means of inflicting of death as a penalty. It has been applied since primeval times for an extensive diversity of offences. The opponents of capital punishment argue that legal executions infringe on the condemned person’s right to life. While the capital punishment proponents frequently attempt to contradict this argument, by emphasizing that, individuals convicted of capital offences have in essence, forfeited their alleged right to life (Batchelder 61). This paper posits to investigate whether the death sentence reduces the motivation to commit homicide and whether it is solid ultimatum to criminals in the U.S.
OVERVIEW OF CAPITAL PUNISHMENT IN THE U.S
In the U.S., capital punishment was introduced by European settlers particularly from Great Britain. The initial recorded execution in the U.S occurred in 1608, in Jamestown. The victim was George Kendall who was put to death on allegations of being a Spanish spy. In contemporary times, in the United States, prisoners placed on death row are normally executed by means of a lethal injection. It is essential to mention that, the U.S is among very few developed countries which still maintain capital punishment. Furthermore, it extremely few countries, which execute mentally sick persons, individuals with extremely low IQ, as well as juvenile criminals. Astonishingly, a huge percentage of individuals as well as the majority of conformist religious denominations in the U.S are pro-life on issues related to abortion and pro-death in regard to capital punishment. These people usually rationalize this position by alleging that they are fundamentally pro-innocent life (Beccaria 102).
As of the year 2010, fifteen states in the U.S had eliminated capital punishment, and nineteen have not refrained from executions since the year 2009. It is evident that, capital punishment is prevalent in the Southern states. In the year 2002, sixty one out of seventy one executions were performed in the Southern states. Away from the South, only California, Missouri, and Ohio had performed executions. Between the years, 1976, when capital punishment recommenced, until 2009, the U.S has witnessed 1,188 executions. This figure includes sixty six executions in 2001, seventy one executions in 2002, and sixty five executions in 2003. There were fifty nine executions in 2004, sixty executions in 2005, fifty three executions in 2006, forty two executions in 2007, thirty seven executions in 2008, and fifty two executions in 2009 (Bedau 65).
Deterrent Effects of Capital Punishment. In the U.S, the question as to whether capital punishment acts as a crime deterrent crime has been subject to debate for decades. The original participants in this debate were criminologists and psychologists. The research carried out by these criminologists and psychologists, was theoretical or founded on comparing crime patterns, in the states with, as well as, the states without capital punishment. On the other hand, since they did not employ multiple-regression statistical approaches, the analyses were not capable to make a distinction between the effects that capital punishment has on murder, from the effects of a diversity of other factors. Several studies allege that commutations, pardons, as well as exonerations, cause an increase in murder, while other studies argue that the time required to complete appeals abates the deterrent effect of execution (Batchelder 63).
There is emergence of new research on deterrence that has been declared as persuasive in academic journals and by outstanding jurists and scholars. Legal academics find the new deterrence proof to be impressive and powerful. They connect it with several decades of consistent data concerning the deterrent effects of capital punishment as the basis of their argument. Their argument holds that, given that capital punishment effectively deters murders, there is an ethical imperative to uncompromisingly prosecute capital offences. Several scholars concur, while finding the proof persuasive. On the other hand, some jurists disregard the apprehension concerning the potential execution of innocent people as executions are enforced in order to realize increased deterrent effects (Paul 3).
Topical studies that detach murders that are deemed as capital-eligible show no noteworthy change in the fullness of time in the rate of murders that are capital-eligible, notwithstanding the variations in the rate of execution. The computations in statistical models are repeatedly flawed. For instance, uncomplicated corrections for huge amounts of mislaid data generate estimates of the deterrent effect that are not different from chance. Employing alternating statistical models, models that explain the strong statistical relationship of murder rates in consecutive years, also generates results that demonstrate that changes in murder rates are statistically isolated to any degree of capital punishment. The studies may as well, irrationally inflate the deterrent effects of executions by disregarding the analyses in done in 1998, thus, not including later years whereby murders reduced, as did the executions. Other studies find the proof of deterrence extremely unstable and fragile, with deterrence estimates changing uncontrollably with the slightest modifications or adjustments either in statistical methods or measurement. Such volatility ought to signal prudence in causal inference, as well as in utilizing these data in informing policy decisions (Beccaria 105).
It is intricate to show categorically the non-existence or existence of any deterrence effect since correlations discovered, or not discovered, in statistical analysis do not entail causation. It is evident that, any individual who refrains from committing capital crimes, owing to a hypothetical deterrent effect of capital punishment, will by definition, on no account be captured in any statistic. This is regardless of the theory that the commencement of capital punishment ought to imply the resultant commencement of a deterrent effect, if any. This should generate a downward movement in crime numbers. The graph below demonstrates that the rates of murder in different states in the U.S that employ capital punishment are higher, compared with the rates in states that do not apply capital punishment.
(Paul 6).
According to the graph above, it is apparent that deterrence does not work. However, this can only be verified when capital punishment ceases to be applied for several years in the future. This would be an appropriate approach in the states that currently apply capital punishment. It would then be accurate to conclude that capital punishment has deterrent effects, in the event that the rates of murder rate following capital punishment abolition do not rise. However, the murder rates may fail to increase owing to other factors. The graph below portrays a different scenario:
(Bedau 65).
Disparities in Capital Punishment Application across States. There are immense disparities in capital punishment application across states. For instance, states differ extensively in their perceived definitions of capital offences, their incidence of imposing capital penalties, their incidence of executions, their execution methods, and the executions’ publicity. These essential disparities may affect the impact of deterrence States’ executions (Paul 7).
Disparities amongst States. An issue that depicts the necessity for a federalized capital punishment is the vast differences between States. Firstly, a number of States apply capital punishment while some other States do not. In the States that apply capital punishment, there are vast distinctions in the incidence of the application of capital punishment, differences in execution methods, and dissimilarity in the types of offences that are carry a punishment by death. In the States that apply the death sentence, there are distinctions by county as to how frequently they seek the death sentence. There was a case from Maryland that is principally alarming. In this case forum shopping was employed to seek the death sentence against Kevin Johns a Maryland defendant. It occurred that Johns murdered another inmate while on a bus transporting them across prisons. The bus travelled across four counties, thus, making it difficult for the authorities to establish where the crime took place. Prosecutors had the case tried in the Baltimore County since the death sentence was sought more in Baltimore County than in the other three counties. In a federalized capital punishment system, this type of forum shopping can be abolished. The federalized system would also place everybody in the country in an equivalent position in so far as the eligibility for capital punishment is concerned. This would mean that, defendants would not be sentenced to death, for their crimes for the reason that they live in the wrong States (Shepherd 12).
There are significant regional distinctions in the United States. Sixteen states do not allow capital punishment, and in eight of the states that allow capital punishment, have not performed an execution in twelve years or more. It is noteworthy that twenty-six of fifty three jurisdictions in the United States, fifty states, the Federal Government, the Military, and the District of Columbia, either do not apply capital punishment or have not performed an execution in over a decade. The majority of those States have not performed an execution, since capital punishment was re-established in 1976. A few as twenty States performed an execution in 2010, and seven States performed more than one, principally in the South. The map below shows the States that apply capital punishment, and the States that do not apply capital punishment in the U.S.
Capital Punishment Map of the United States
(Batchelder 73).
State By State Depiction of Inmates on Death Row in the U.S
In the United States, the average duration of time an inmate may spend on death row is fifteen years. In the year 2009, of 3173 prisoners on death-row, 113 had been in prison for above twenty nine years. The diagram below shows the State by State depiction of inmates on death row in the U.S (Shepherd 22).
CONCLUSION
The question begs as to whether capital punishment can reduce the incentive to commit homicide and be a solid ultimatum to criminals. As it has been demonstrated in this paper, it is difficult to establish the fact one way or the other. Capital punishment is much more probable to act as a deterrent, in the event that the crime necessitates preparation and the potential criminal has adequate time to reflect on the likely consequences. On the other hand, where the offence is committed in ad hoc, there is no possibility that any penalty would act as a deterrent. In this regard, there is a spirited argument for ensuring that murder committed in such ad hoc circumstances not punished by death or for establishing degrees of murder. However, anti-death sentence activists constantly argue that, death cannot be a deterrent, and frequently site several studies based on American states to attest their point. In the opinion of this paper, capital punishment is a deterrent to reduce the incentive to commit homicide and can be a solid ultimatum to criminals.
Works Cited
Batchelder, N. Reasons to Abolish the Capital Punishment: Oklahoma Coalition to Eradicate the Death Sentence. Journal of Legal Studies, 14.8 (2011) pp. 61-73. Print.
Beccaria, C. Crimes & Punishments and Related Writings, Cambridge: Cambridge University Press. 2009. Print.
Bedau, H. Death Penalty in America: Contemporary Controversies, New York: Oxford University Press. 2011. Print.
Bosworth, M. Race & Punishment, Punishment and Society, 2.1 (2010) pp14–18. Print.
Paul, Z. Deterrence, State Executions, & the Incidence of Homicide. Applied Econ, 24.8 (2011) pp. 3-7. Print.
Shepherd, J. Executions, Deterrence, & the Characteristics of the Victim. Criminal Justice Studies, (2011) pp12- 22. Print.
Montgomery Cares Program
Montgomery Cares Program
Student’s Name
Institution
Montgomery Cares Program
Enterprise Economic Model for Sustainability
Montgomery Cares program is one of the successful and leading programs in Montgomery County, Maryland. It was recognized as a center that offers, as well as provides basic health care to low-income, adult uninsured county tenants through monetary support to pubic-municipal clinics. Implementation and inception of the program began nine years ago in July 2005 with initial funding of 5 million US dollars. The funds accruing to the program, obtained from government grants and county allocations is scheduled for an annual increase to the operational cost of approximately 15 million dollars in FY 13. Interestingly, Health care services at the center are provided through Community Health Link, a system of not-for-profit community health care providers in Montgomery County, Maryland.
In the preceding years, the number of Patients being attended to at the Montgomery health care service has increased by 25.1 percent and total number of patient calls increased 12.0 Percent after the enactment of the health service program. Moreover, it is worth noting that growth in the total number of patients seen varied across Montgomery Cares clinics. For instance, in one of the clinics, there was a growth of more than 51 percent in the number of patients seen, while other two clinics had roughly uniform growth (Centers for Disease Control and Prevention, 2012). Nonetheless, there never misses an exception in the research, with merely one among seven to eight clinics, the number of ailing people visiting rose. Interestingly, this occurred at each of the Montgomery Cares clinics. On the other hand, enormous, factors other than Montgomery Cares contribute tremendously, to the growth in patients seen and in the number of patient visits. Consequently, it is evident that more work needs in order to straighten out the particular impact of Montgomery Cares.
Montgomery Cares Patients are largely minority women with substantial health care needs. The population distribution of the people around the vicinities of Montgomery Care is primarily a diverse one. That is, is mainly composed of the immigrant population; this is evident with about three quarter of patients, reporting that they are non-citizens of America, or were born outside the U.S. Hispanics represent the leading percentage of patients (59 percent), followed by blacks (9 percent) and Asians (7 percent). Nearly three-fourths of patients are women, and nearly half are parents of minor children (Centers for Disease Control and Prevention, 2012). Nearly half of patients are employed and work full-time. The majority of patients—nearly two-thirds—either have never had health cover or have been without cover for many years. Approximately half valued their health as either fair or poor and more than three-fourths showed signs of having lingering conditions (such as the different types diabetes or cardiac diseases), and more than a third reported two or more such illnesses. Hypertension and diabetes respectively affect at the very least one-quarter of the entire sample population of patients attending Montgomery Cares (Centers for Disease Control and Prevention, 2012).
On one hand, gaining access to Care is a task, but once there, satisfaction with care provided at Montgomery Cares Clinics is high. In one of the surveys conducted on appointment accessibility, it is evident that approximately, one in four potential patients is inept to get hold of reach a medical profession when doing all he or she can to call for an appointment (Business Group Health, 2012). Moreover, only 28.1 percent of potential patients whom their calls are received (and 21.1 percent of all callers) perhaps were able to obtain an appointment successfully. Among Montgomery cares patients, nearly 41 percent gave an account of poor service or encountered difficulty in contacting the clinic during business hours (Business Group Health, 2012).
Further, half of Montgomery Cares patients reported noteworthy difficulty gaining access to care and of those, one in four recounted that the inability to get finished on the phone was a significant obstacle to care (American Heart Association, 2013). In terms of gratification, respondents by large reported contentment with the care received at the clinic, with 75.1 percent reporting being satisfied or very satisfied with the care. In addition, satisfaction assessments were relatively high across an array of variables gauging diverse features of medical care and services, with semi- or more of patients answer back positively to the various categories (American Heart Association, 2013). Evidently, the more effectively care providers listened, the the most easy communication turned out to be for the provider. Moreover, the thoroughness of the exam highly depends on the established respect, patients are treated with and how much time the clinical care providers spent during a patient’s visit.
Case analysis: Diabetic Patients
Data collected and reported for diabetic Montgomery Cares patients is inadequate for measuring quality of care. Montgomery Cares clinics collect and record facts for diabetic patients in automated form (using a database system called “CVDEMS”). However, the data collected is incomplete. 30.1 percent of visits in patients’ hard copy medical records remain unrecorded in CVDEMS (American Heart Association, 2013). Almost half of patients had their medical record data linked to their smoking practices, but no such data existed in CVDEMS. Further, only one-quarter of patients who concluded the diabetes edification had that logged in both the electronic and hard copy medical record.
The assessment data provides a print of current Montgomery Cares clinics, the patients they attend to, as well as serve, and patients’ past ailments and experiences, and establish a reference point against which imminent changes can be paralleled (American Heart Association, 2013). The data also allude to steps clinics may need to emphasize and prioritize in order to help mold the efficacious advancement of Montgomery Cares, include the following:
One entails the improvement in patients’ access to a live vocal sound at the end of the receiver line. This is essential especially to psychiatric patients, who may need live conversations in order to improve on the cognitive abilities. Further, increasing the availability of appointment slots may have a multiplier effect to Montgomery economy. Employment induces personal development and this literally spiral down to the community.
On the other hand, working to minimize the time spent by patients waiting for medical attention is perhaps an essential consideration. Too many backlogs hinder efficiency and performance in an organization (American Heart Association, 2004). On another perspective, it is better off to identify patients’ needs such as language need in order to increase the accessibility of multilingual organizational staff and/or transcriber services. As such, this sharpens providers’ attention to potentially under-diagnosed conditions.
Finally, it would be prudent for medical providers to make whole and precise data collection a priority (American Heart Association, 2004). This perhaps may be expedited by the use of automated applications customized for medical settings, as well as the integration of medical experts proficient in information technology and its application. Coupled with this is the maintenance commitment to ensuring patients obtains guideline-appropriate defensive care and endorsed a care for chronic conditions (National Cervical Cancer Coalition, 2013).
References
American Heart Association. (2004). Why Blood Pressure Matters. Updated June 2012.
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureM
atters/Why-Blood-Pressure-Matters_UCM_002051_Article.jsp
American Heart Association. Understanding Blood Pressure Readings. Updated March 1, 2013.
www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/
Business Group Health. Evidence Statement Cervical Cancer Screening.
http://www.businessgrouphealth.org/benefitstopics/topics/purchasers/condition_specific/e
videncestatements/cervical cancer_es.pdf (June 7, 2012)
Centers for Disease Control and Prevention (CDC). (2012). National Diabetes Fact Sheet, 2011.
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf (June 15, 2012)
Centers for Disease Control and Prevention (CDC). (2012). Diabetes Public Health Resource: Basics about Diabetes.
http://www.cdc.gov/diabetes/consumer/learn.htm (June 15, 2012)
National Cervical Cancer Coalition. (2013). Prevention. www.nccconline.org/index.php/prevention (June 5, 2013)
Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp (April 4, 2012)
National Cervical Cancer Coalition. (2013). Prevention. www.nccconline.org/index.php/prevention (June 5, 2013)