21st-century Organizations Face Different Challenges From Those of The Essay

21st-century Organizations Face Different Challenges From Those of The Past - Essay Example Environmental catastrophism is a result of changes in climate. Weather patterns keep changing and sea level keeps rising whenever there are changes in climate. It is estimated that gradual changes in weather could cause 40% of world population to fall into the risk of falling victims of limited natural resources like water, pasture, energy and cultivatable land (Easterling et al, 2000, p. 2070). The poor and the less influential people will have little or no control over resources thus likely to suffer due to lack. To be able to establish their position in the society, there is a high likelihood of eruptions of violence as more people fight for a share of the limited resources. To resolve the conflicts, governments will need to have negotiation traits if peaceful coexistence will be achieved once again. South America has already started facing the negative impact of globalization and climate change since there has been an increased threat to livelihoods of the poor. For instance, during the 2008 global recession, there was a significant increase in the use of food items in exchange for crude oils (Nazlioglu & Soytas, 2011, p. 490). That together with other global related issues led poor people in the south to suffer since most households could not afford the basics like food due to the high prices at the time. The blame was placed on the Northern governments who had failed to invest in alternative drivers of the economy like agriculture. This led to malnutrition among the poor hence causing a critical humanitarian crisis at least for the next few years. It is estimated that there are more than expected countries that have been exposed to political and economic conflicts that end up affecting accessibility to basic resources (Iqbal, 2006, p. 641). Developed countries have also imposed wars aimed at victimizing the poor countries hence leading to more devastation that influences the quality of life in poor countries.  

Software Requirements Specification Essay Example for Free

Software Requirements Specification Essay 1. Introduction 1.1 Purpose Online Shopping Software main purpose is to provide customers with the possibility to perform online purchases on products already on store. Customers are identified properly and are able to perform online transactions using three kind of methods: either using credit card or banking documents, but also through PayPal account. Online Customers are divided on two categories upon user account types: basic and business. Basic accounts beside other attributes contain a specific one named Fidelity which deals with the number of years the user has been joining the online shop. On the other hand is business plan which is characterized uniquely by the Volume attribute that is the total amount of transactions performed within the online shop. The customer is able to operate throughout the system after properly authenticated. He is able to create a cart and add products to it or delete them as well. Then he decides whether he might go on with the checkout operation and complete the purchase. Once the user decided upon the plan to use: basic or business, he is given the alternatives to pay through the previously mentioned methods accordingly. Once the purchase is confirmed by the customer and admitted by shop commission, customer details come into use in order to define the shipping address and other supplementary information. Customer is given the possibility to view and print some information regarding his activity on the shop. For instance he can print the number of purchases completed by him from eh beginning of the current year. He can print the status of previously performed purchases and decide whether to cancel or not a specific purchase if it is still in â€Å"Not available† status. During the process of product selection and addition to cart specifying correspond quantity the system automatically checks if the product is available within the quantity or not. In case of negative response the system generates a request to the product supplier. Stated in short terms this is the overall situation on hand. 1.2 Document Conventions Specific terminology is used throughout the specification of the system. User Profile: stands for the profile of the customer (person) opened in the software. One person can have multiple profiles using different emails. A profile can be linked to none or one account type. Person: defines an real person who has an identity defined by class attributes. A person can have multiple profiles and consequently multiple accounts. For instance a person can have a basic and a business account. Account: defines an entity that enables the user to operate throughout the system and perform purchases. It is the super class of two other classes respectively: Basic and Business which extend the super class. Payment: defines an entity that enables an account to perform a payment transaction using one of alternative methods. Purchase: defines an entity that encapsulates a purchase object. A purchase is specified by a unique number and status thus using the Status class. Cart: stands for a container that holds selected products during the session and is included by a purchase. Cart Products: as the name itself defines an entity that makes possible operations of addition, deletion, and selection of products in and from the cart. Bank Transfer: stands for a payment method when using a basic plan. Credit Card: stands for a payment method using a credit card when using a basic plan. PayPal: defines a payment method when using business plan. In this case it includes a PayPal service using a previously configured PayPal account. 1.3 Intended Audience and Reading Suggestions The system is worth using by an audience that is interested on buying online products and benefit from facilities offered in such a case. Facilities are: saving time, saving money by selecting the best offer, comfort circumstances, safety of money transactions etc 1.4 Project Scope The scope of this project is to design and develop a system that is necessary to shops when they need to operate online, sell products online. The shop can keep an electronic history of all purchases and transactions. This gives more control over the operations that the company offers. The system can be adapted to a range of shops from simple small ones to big markets. A shop can outsource the function of shipping to another external company or can handle it itself. Project scope also includes financial transactions that call for other third party services like PayPal. Project scope from customer perspective, limits the range of customers to only those who have internet connation on some form and have a bank account in hand. The aim of this project is to promote an efficient, user-friendly, time-fashionable, safe way for customers to bye and receive products without being physically at a shop thus using virtual money. 2. UML Diagrams 2.1 Use Case Diagrams Online Shop from user perspective use case Description: This use case provides the viewpoint for the whole process from user perspective. Customer sees only the necessary functions that the system must define. Actors: Online Customer Preconditions: Customer must have a bank account. Base Case: 1. Customer must log in and authenticate 2. 3. 4. 5. 6. Customer must choose the type of purchase to perform Customer can view and select products Customer can perform a purchase Customer can cancel a purchase He can view additional information regarding the purchase Alternative Flows None Post conditions: Customer performs transactions based on defined accounts. Additional Info/Issues: None View Products Use Case Description: View products use case describes the whole operations a user can perform on a product currently on the store. It also describes an exceptional case when a product is not available on the quantity required. Preconditions: Customer must login and authenticate firstly Base Case: 1. Customer can view the products 2. he can select the products 3. 4. 5. 6. 7. he can add the products to cart he can define quantities on ordered products system checks whether the quantity is satisfied or not system responds to client with approving the purchase system generates an automatic order to products supplier Alternative Flows None Post conditions: Customer performs transactions based on defined accounts. Additional Info/Issues: None Make Purchase Use Case Description: This use case defines the cycle when customer makes a purchase. When deciding to perform a purchase the customer proceeds to the checkout operation and then to the payment method and according verifications. Preconditions: Customer must confirm the final form of the cart and products already in. Base Case: 1. Customer must complete with the cart 2. he is taken to the checkout step 3. he is forwarded to a payment method based on the purchase type that he decided beforehand. Alternative Flows The customer may cancel the purchase when it is in â€Å"Not Available yet† status. Post conditions: Customer performs transactions based on defined account. Additional Info/Issues: Includes third party accounts like PayPal or supporting bank documents. Payment Use Case Description: Payment use case deals with the cycle of performing a payment through on of the methods mentioned. Preconditions: Customer must authenticate and decide upon the type of purchase to commit. Base Case: 1. Customer decides on the type of method to pay using either credit card or providing bank documents in case of basic type of purchase. 2. he decides upon PayPal method to pay if he decides on business purchase type. 3. each of the methods forward the user to the corresponding sites where he can enter credit card info, or upload a document or confirm a PayPal account. Alternative Flows None Post conditions: Customer performs transactions based on defined account. Additional Info/Issues: Includes third party accounts like PayPal or supporting bank documents.

Inflation Rate and Economic Stability of Brazil

Inflation Rate and Economic Stability of Brazil Introduction This paper is concerned with the economic consideration of one of the South American countries and analyzes the impact of an economic concern on that particular South American country that has been chosen and identifies the trend of the economic concern with in specified region on the basis of data sets accumulate from the source. The south American countries has major impact on American economy and the economic concern of one of an important country raise our body of knowledge regarding the economic trend in that particular country and its impact on overall economy as well. South American Country The economy of South America consists of twelve nations with three territories and comprise of 6% of population in the world. I have choose Brazil among other South American countries as Brazil is the largest South American country and Brazil is one of the fastest growing economies of the world. It is ranked at fifth spot in the world regarding population and geographical region and fifth largest economy regarding GDP in the world. The economic concern of Brazil is effectively contributes to world economy and interesting trend of economy can be seen. (Abreu, 2005). Economic Concern Among four economic concern including GDP, quantities of specific Goods and services gross Domestic Product (GDP), and unemployment inflation I have selected inflation. Inflation is an important economic concern that will effect the economy in great extend and inflation rate of a country economy is an important indicator for a country growth prospective. Inflation means rise in the general price level of the country and loss the real value of money as fewer commodities will bought with each additional unit of currency. Inflation directly relate to the economic productivity and has positive and negative both effect on economy as it create economic uncertainty which may discourage saving and investment. High prices of general commodities and hoarding will be its largest disadvantage. In positive sense it may encourage non monetary investment. But the inflation rate needs to be control in order to sustain country economy. Inflation trend in Brazil The inflation rate in Brazil is fluctuating over the years. No consistent trend can be seen in the inflation rate ac past year data support this assumption. According to the data displayed by ( IPCA) in 2002 the inflation rate was 12.53% that is quite high rate. Then the decreasing trend of inflation rate can be seen in Brazil economy as 9.3% in 2003, 7.6% in 2004, 5.69% in 2005, and 3.14% in 2006 that is least in this decade. Then the slight increasing trend can be seen in rate of inflation. 4.46% can be seen in 2007 and 5.91 in 2008. The fluctuating trend can be seen in this range in coming years as well. (Inflation Statistical table) Statistical Table Inflation (IPCA) 2002 12.53% 2003 9.30% 2004 7.60% 2005 5.69% 2006 3.14% 2007 4.46% 2008 5.91% Past two years Inflation Trend Past two years monthly inflation rate trend can be seen from this graph that shows the monthly frequency of the inflation rate. The graph bars shows the trend of inflation from year 2011 that is 6.01%. The increasing slope can be seen from March, 2011 up to October, 2011. Inflation rate at the month of October is the highest that is 7.31%. Then the control implementation on inflation increasing trend can be seen from 7.31% to the deep low rate at 4.92% in July, 2012 that is complemented to Brazil economy. The upward Trent at semi annual bases can be seen in Brazil economy. The last recorded inflation rate of 6.15% that is quite high. Brazil government target inflation rate is 4.5% with the plus and minus tolerance margin of 2% in it. The high inflation trend is important consideration for the government as increasing inflation rate affect the economy in deep roots and make the investment and saving difficult. People purchasing power will be effected that will effect their standard of living and indulge the poverty level in the country as commodities will be difficult to purchase with even more money in hand because due to inflation country will lose its real money value. (De Paiva Abreu, 2005). According to IBGE report it is recorded from 1980 the Brazil inflation trend has gone through various fluctuations. Historical data shows average of 411.8 % Brazil inflation rate that reached at highest rate of inflation of 6821.3 % in April 1990 that was the highest rate for all time. The low inflation rate of 1.7 percent was found in December 1998. The measure used to calculate inflation is consumer price index. Brazil important contribution in consumer price index are tobacco, food and alcohol that covers 31% of total, 15 percent by transport sector and communication carries 5 %. . (Brazil Inflation Rate) Statistical Evidence comparing various countries inflation rate Inflation Rate of various countries is showing the Brazil high rate of inflation as compare to other countries except India that has the inflation Rate o f 6.62. An increasing trend is quite threatening for Brazilian government for economic growth and required close consideration to control the rate in future in order to stabilize the economy. Conclusion The Inflation rate and economic stability are closely related to one another and required close concern in order to stabilize the economy. Brazil increasing trend provide the threatening for its future concerns and shows that the government need to closely consider this regime in order to stabilize the economy and to achieve the economical growth in the world.

Antonio Vivaldi and the music of his time :: essays papers

Antonio Vivaldi and the music of his time Throughout history there have been many distinct periods of time. These various eras are all alike in a way because they all slowly flow into each other. One of these unique times was called the Baroque period. The Baroque time began during the 1600's and ended early during the early 1700's. The way Baroque music was looked at was varied depending on where you looked at it from. In Italy, it was largely energetic and spectacular. Yet, if you were to travel North, you would encounter the "gloom's of muted firelight." This, along with the "shadowy pales of another world," simply means that this music wasn't greatly appreciated in Southern Italy, as it was more towards the North. The people of the North were not as affectionate towards this type of music. Although, the more time that had passed in the 1600's, the more popular the baroque music became. It was greatly adored by the listeners. The beauty that this type of music contained was extremely astonishing. Also the drama in this type of music and theatre was what made this time stand out from the rest. The actual term "baroque" is extracted from "baroco" which is a name used by medieval philosophers to identify a reasoning that writers of the 16th century found absurd and pointless. On the contrary, Baroque music is far from being absurd or pointless. The word "baroque" is derived from that or from the word "barrochio" that is an Italian word used since the middle ages to indicate shifty or tricky procedures. Wherever it's beginnings, the word "baroque" had been used since the 18th century to indicate paintings, poems, architecture, literature, and all else that is dynamic, dramatic, and to some eyes, astonishing and incredibly even ugly. This really comes to a surprise to me because I've listened to baroque music like Antonio Vivaldi and Johann Sebastian Bach and none of the music struck me as being "ugly." The first word that came to mind when I was listening was "relaxing." Like all other music, there are some people that think higher of it then others. Sir Francis Bacon said, "^Ã…I cannot but be raised to this persuasion, that this third period of time will far surpass that of the Grecian and Roman learning^Ã…" After reading this quotation you can clearly see that Sir Francis Bacon thinks the Baroque time is far superior to the Grecian and Roman periods. Antonio Vivaldi and the music of his time :: essays papers Antonio Vivaldi and the music of his time Throughout history there have been many distinct periods of time. These various eras are all alike in a way because they all slowly flow into each other. One of these unique times was called the Baroque period. The Baroque time began during the 1600's and ended early during the early 1700's. The way Baroque music was looked at was varied depending on where you looked at it from. In Italy, it was largely energetic and spectacular. Yet, if you were to travel North, you would encounter the "gloom's of muted firelight." This, along with the "shadowy pales of another world," simply means that this music wasn't greatly appreciated in Southern Italy, as it was more towards the North. The people of the North were not as affectionate towards this type of music. Although, the more time that had passed in the 1600's, the more popular the baroque music became. It was greatly adored by the listeners. The beauty that this type of music contained was extremely astonishing. Also the drama in this type of music and theatre was what made this time stand out from the rest. The actual term "baroque" is extracted from "baroco" which is a name used by medieval philosophers to identify a reasoning that writers of the 16th century found absurd and pointless. On the contrary, Baroque music is far from being absurd or pointless. The word "baroque" is derived from that or from the word "barrochio" that is an Italian word used since the middle ages to indicate shifty or tricky procedures. Wherever it's beginnings, the word "baroque" had been used since the 18th century to indicate paintings, poems, architecture, literature, and all else that is dynamic, dramatic, and to some eyes, astonishing and incredibly even ugly. This really comes to a surprise to me because I've listened to baroque music like Antonio Vivaldi and Johann Sebastian Bach and none of the music struck me as being "ugly." The first word that came to mind when I was listening was "relaxing." Like all other music, there are some people that think higher of it then others. Sir Francis Bacon said, "^Ã…I cannot but be raised to this persuasion, that this third period of time will far surpass that of the Grecian and Roman learning^Ã…" After reading this quotation you can clearly see that Sir Francis Bacon thinks the Baroque time is far superior to the Grecian and Roman periods.

Family Medicines: a Strategic Weakness Essay

Recently the trends of urbanization and fast population increase expose several problems to healthcare system in Vietnam like shortage of healthcare manpower, low quality of care, unreasonable distribution of healthcare manpower in different geographic areas, particularly the serious shortage of physicians in Mekong Delta and North-west highland areas as specialists tend to locate their practices in urban medical centers where they could have access to advanced technology, supportive services and consultations from other specialists while rural areas are underserved and patient care becomes highly technocratic, fragmented and episodic. Furthermore, the shortage of physicians in major cities results in a seriously permanent overload at Central level and some specialty hospitals like Oncology, Pediatrics, Obstetrics and Gynecology .. etc.. In sustainable issues, deficit of Family medicine – a basic foundation of modern healthcare in the world, is identified as one of main causes of such problems in Vietnam healthcare system. The purpose of this Essay is to provide a theoretical discussion and analysis about the Family medicine weakness in Healthcare system and Family physician insufficiency in Vietnam to better understand about their impacts to the healthcare system at present and some proposed solutions and recommendations to improve these deficits. 2. Family Medicine and its roles in global healthcare system. In contemporary medicine, Family medicine remains the foundation stone of healthcare service in the community. As the most interesting and challenging of medical disciplines it is based on six fundamental principles: * primary care * family care * domiciliary care * continuing care All above principles are all designed to achieve: * preventive care * personal care (Pereira Gray, 1980). In the contemporary climate where medical services are fragmented and there are competing interests there is a greater need than ever for generalists. In those principles, primary care is the backbone of the health care system and encompasses the following functions: * It is first – contact care, serving as a point of entry for the patient into the healthcare system * It includes continuity by virtue of caring for patients in sickness and health over some period * It is comprehensive care, drawing from all the traditional major disciplines for its functional content. It serves a coordinative function for all the healthcare needs of the patient * It assumes continuing responsibility for individual patient follow-up and community health problems * It is a high personalized type of care (Rakel 2011) In the 2008 report, the World Health Organization (WHO) reaffirmed the importance of primary health care with its report â€Å"Primary health care now more than ever† and its emphasizes that primary care is the best way of coping with the illnesses of the 21st century, and that better use of existing preventive measures could reduce the global burden of disease by as much as 70%. The commentary emphasizes that ‘primary care brings promotion and prevention, cure and care together in a safe, effective and socially productive way at the interface between the population and the health system’. The key challenge is to â€Å"put people first since good care is about people† (WHO, 2008). Rather than drifting from one short-term priority to another, countries should make prevention equally important as cure and focus on the rise in chronic diseases that require long-term care and strong community support. Furthermore, at the 62nd World Health Assembly in 2009, WHO strongly reaffirmed the values and principles of primary health care as the basis for strengthening health care system worldwide. The essence of Family medicine is continuity of care and the evidence for its contribution to quality of care and better outcomes as follows: * Lower all cause morbidity * Better access to care * Less re-hospitalization * Fewer consultations with specialists * Less use of emergency service Better detective of adverse effects of medication interventions. Role definition of Family physician varies considerably both among family physicians and among people with whom they interact. Some individuals, particularly other medical specialists, see family medicine as merely another name of general practice. For others, family medicine is synonymous with primary care. A large proportion of family physicians further elaborate their role to include emphasis on personalized and humanized care. A smaller group adds a third component to their role: caring for families. The largest proportion who subscribes to this last notion refer to family physicians’ treating all members of a family (Cogswell, Sussman, 1982). In view of Family medicine, Family physicians are generalists who primarily draw their scientific medicine and technical expertise from five older specialties – internal medicines, pediatrics, surgery, obstetrics-gynecology and psychiatry-neurology. Compared to these specialties, family medicine is still a young field marked both by rapid expansion and by change, variety, ambiguity and conflict in the images and definition of the role of family physician. As the largest caring scope in healthcare services, the quality and quantity strengths of Family physician force play key roles to improve the health quality of national population. Globally the scope of Family medicine is extended with the recent view of global health care which is a field at the intersection of several disciplines: epidemiology, economics, demography and sociology. The term global health, as opposed to international health, implies consideration of the health needs of the people of the whole planet above the concerns of particular nations. That means global health has wide scope and reach to equity that the term of international health. The â€Å"global health† concept in Family medicine raises the changes in primary care nature as follows: * All population has to deal with the same risk of health due to the phenomena of traveling and immigration. Increase the gap between the poor & the rich globally. * The process of the urbanization/globalization. * Increase of the population in the world. * Decrease of the resources for health care. * Global warming phenomena. * Vaccination Era. * Evidence Based Medicine in daily practice. * Increase the bad behavior such as fast food, tobacco, stress, use alcohol†¦ * Primary health care change to Primary care concept  (Pham Le An, 2009). Such comprehensive changes upgrade the scale of Fami ly medicine in healthcare. In order to promote the global health support as well as strengthen the co-operation of national members, the World Organization of National colleges and Academies (WONCA), World Organization of Family physicians in WHO, was officially established and based in Singapore after the Fifth World Conference on General Practice in Melbourne in 1972. 3. Family medicine situation in Vietnam Although Family medicine basis had been established in the world for over 40 years, Family physicians, the most recently recognized specialists in Vietnam, are in the enigmatic situation of developing the occupational role which they simultaneously occupy. Family medicine had been only approved for establishment by Vietnam Ministry of Health since 2000. Until 2003, Family medicine specialty was established at 3 Medical Universities of Hanoi, HCMC City and Thai Nguyen province to train Family physicians and its specialists. However, its development was spontaneous with 7 Family medicine clinics (in both public and private sectors) nationwide and not strategically organized at all levels so far. There are only 59 post-graduated specialists and around 1,1 General practitioners who partly handle the roles of family physicians per 10,000 people averagely. The imbalance between Family medicine and other specialists can be seen by the ratio of 7,2 Medical doctors per 10,000 people in overall (Vietnam General Statistics Office – GSO – 2011) and the healthcare system only satisfies about 60- 70% of the demands and are lower than neighbor countries like Thailand, Singapore, Malaysia, Philippines.. tc. In 2011 report, Vietnam Ministry of Health forecasted the demand of 34,000 General practitioners more to obtain 10 Medical doctors/10,000 people in 2020 and this is a significant challenge to all 19 Medical educational Universities/Colleges to educate Medical doctors and post-graduate levels in medicine which capacities supply 4,800 graduated Medical doctors every year to add around 3,500 physicians more a year. Not only the quantity of family physicians is seriously insufficient, but also their quality to fulfill the roles of a family physician does not meet the needs of the patients and social development. The General practitioner training programs don’t orient student to the WHO’s critical requirements of â€Å"good doctors† in Family medicine, even though the criteria are more and more demanding by time, for example, the newer criteria of John Murtagh in 2001 â€Å"What makes a good General Practitioner? : * Develop rapport and good communication skills * Ask the right questions * Be astute and observant * Develop optimal ethical and professional standards * Have a fail-safe diagnostic strategy * Develop supportive networks * Know essential therapeutics * Develop basic procedural skills * Be well prepared for emergencies * Know yourself and your limitations including own general practitioners. The importance of certain specific competences and soft-skills in family physician force are emphasized in many studies. An interesting survey on patient care by representative health consumers conducted at St Vincent’s Hospital Melbourne revealed that the most important attributes of good doctors were (in some order of importance) caring, responsibility, empathy, interest, concern, competence, knowledge, confidence, sensitivity, perceptiveness, diligence, availability and manual skills. Additionally, there are neither comprehensive residency programs for Family physicians at Medical Universities/ Colleges in Vietnam nor supporting policy to them and general practitioners practicing at remote or rural areas so far. With effort to resolve the overload situation of Central hospitals in major cities, Project 1816 of Vietnam Ministry of Health deployed in 2008 with the purpose of â€Å"Fielding rotated professionals from upper level hospitals to lower levels to improve the quality of medical care† achieved some initial results such as transferring some technologies and conducting on-site training to improve skills and qualifications for lower level health care professionals; initially improving the quality of medical care at lower levels, especially in the mountainous, remote areas with staff shortage†¦etc, but its couldn’t obtain one of basic goals to reduce overcrowding for upper level hospitals, especially central level hospitals because it made the shortage of central level and specialty hospital more serious by the rotation. 4. Impacts of Family Medicine weakness in Healthcare system & Family physician insufficiency in Vietnam. Due to low reliability and poorly structured family physician network, patients tend to bypass to specialists/ central level hospitals (Vietnam Ministry of Health – 2011 Report), opposite with the trend in the world in which healthcare activities for chronic diseases such as diabetes, hypertension, asthma†¦are moved from in-patient to out-patient services with comprehensive treatment protocol at each level (Dang Van Phuoc, 2012) The irregular bypass causes the overload at Central level and specialty hospitals and the overloading condition becomes more serious, i. e, bed using capacity at Central hospitals increase from 116% (2009) to 120% (2010) and 118% (2011). It’s extremely high in some specialty hospitals such as K (Cancer) Hospital: 249%, Bach Mai Hospital: 168%; Cho Ray hospital: 154%; Central Obstetric and Gynaecological hospital: 124% .. etc. High capacity occurs in some specialties such as Oncology, Cardio-vascular, Orthopaedics (at 100% of hospitals), Obstetrics and Gynaecology, Paediatrics (at 70% of hospitals) while 36,8% of General hospitals are overloaded. The similar situation also happens in Consulting Departments with 80 exams/day/doctor while 60% – 80% of patients at Central level hospitals could be examined at local level and 40% of surgery cases at Central level hospital could be performed at local levels (Ministry of Health – Plan to decrease workload of Central level hospitals 2012- 2020) With the cost in health care, the deficit of Family medicine in Vietnam is one of reason making the medical expenses of patient higher. Total Expenditure on health as % of GDP (5. 1) is fairly high while General Government expenditure on health as % of total expenditure on health (28. 5) is so low to neighbor countries (Susan, 2005). The most cost-effective healthcare systems depend on a strong primary care base. This has been confirmed by a variety of studies comparing the care given by physicians in different specialties because primary care provided by physicians specifically trained to care for the problems presenting to personal physicians, who know their patients over time, is of higher quality than care provided by other physicians. When hospitalized patients with pneumonia are cared for by family physicians or full-time specialist hospitalists, the quality of care is comparable, but the hospitalist incur higher hospital charges, longer lengths of stay, and use more resources (Smith et al. , 2002). Similarly, the greater quantity of primary care physicians practicing in a nation, the lower is the cost of health care. The cost of healthcare is inversely proportional to the percentages of generalists practicing in that nation. According to OECD Health (Organization for Economic Cooperation and Development – OECD Health Data, June 2005), United Kingdom has twice the percentage of family physicians but half the cost to U. S.. Administrative overhead accounts for a major part of the high overhead cost (31%) of U. S. health care (Woolhandler et al. 2003). Countries with strong primary care have lower overall health care costs, improved health care outcomes, and healthier populations (Starfield, 2001; Phillips and Starfield, 2004). The shortage of Family physicians and Family medicine deficits also cause other problems in health care as follows: * Incomplete or unsuccessful Primary health care performance. * The gap between urban care and rural care in the health care network. * The competition among specialties: lack of cooperation in chronic disease care, increase the cost of management. * Barrier in teaching ambulatory care and doing out-patient’s research in academies (Pham Le An, 2009). In society, Family medicine meets some resistances of patients such as family hysicians are unfairly treated as â€Å"general consultants†, â€Å"home caring doctors† and even in medical community, they are considered as â€Å"incompetent doctor†, â€Å"poor specialist†, â€Å"unfair competitive doctor†.. e tc. Many other specialists and hospitals’ managements list Family physicians as one of financial losing causes to their hospitals. Such unfair treatments make many Family physicians feel uncomfortable with the specialty and their roles of Family physician. The reliability of patients and society to them is fairly low and this specialty does not attract the general practitioners to study. 5. Some proposed solutions & recommendations to improve Family medicine. In order to improve the Family medicine in Vietnam, it requires a comprehensive strategy with strong supports of government, educational institutes and society. Within the limit of this essay, I would like to propose some solutions and recommendations as follows: a. Increasing the quantity of Family physicians with additionally trained General practitioners and using the retired medical doctors: The greater the number of primary care physicians in a country, the lower is the mortality rate and the lower cost (Rakel, 2011). In the United States, a 20% increase in the number of primary care physicians is associated with a 5% decrease in mortality (40 fewer death per 100,000 population), but the benefit is even greater if the primary care physician is a family physician. Adding one more family physician per 10,000 people is associated with 70 fewer death per 100,000 population, which is a 9 reduction in mortality (Rakel 2011). A study of the major determinants of health outcomes in all 50 U. S. states found that when the number of specialty physicians increases, outcomes are worse, whereas mortality rates are lower where there are more primary care physicians (Starfield et al. , 2005). Starfield (2000) states, â€Å"the higher the primary care physician-to-population ratio, the better most health outcomes are† (p. 485). Researches in England reveal that with each Family doctor more in 10,000 people (about 20%), adjusted mortality will reduced about 5% in chronic diseases (Gulliford 2002). The increase of Family physicians obviously reduces the workload at Central level and specialty hospitals (49. 3% of out-patient and 59% of in-patient totally) because with many researches in the world, over 90% of patients are taken care with better service by Family physicians in developed medical or developed countries (Didier, 2011). They can help patients and their relatives in 80% health problems: acute or chronic diseases without complications or no need to transfer to Specialty hospitals (Dang Van Phuoc, 2012). To compensate the continuing decline of the number of students entering primary care as a common trend in the world (Bodenheimer et al. 2009) and insufficiency of graduated general practitioners, a policy to support general practitioners and retired medical doctors to practice as Family physicians such as additional training about Family medicine, financial supports, incentive†¦should be prepared and implemented. Rather than other countries where Family physicians usually work at home or their private clinics, Vietnam has a wide network of local level medical centers at wards/hamlets and popularly private clinics/medical units. This advantage allows Family physicians to practice and deploy the primary care programs easily and popularly. b. Family physician residency training programs: Quality of care and the inadequacy of medical training are two major concerns of Family physicians. Eventually, medical schools and residency programs graduated more specialists and fewer physicians trained for primary care. To improve their quality of care in accordance with global health principles, proposed solution is to build emerging curricula of family practice residency programs to envisioning family physicians as â€Å"horizontal specialists† who can deal with the large majority of patients’ needs on a continuing basis (Rakel, 2011) and envisioning this role as integrating humanized care with a high level of competence in scientific medicine. In contrast to the training of the general practitioner, the additional training that family physicians receive is intended to make them more proficient generalists in scientific medicine through formal training in appropriate interpersonal skills and in the behavioral and social sciences. Implementation of this role, however, requires reorganization within the medical system (Folsom, 1966) for continuing, comprehensive care by primary physician is difficult if not impossible within the normative organizational structures of highly specialized medical centers. As Family physicians play the important role in primary care, the Global health awareness program should be combined into General practitioner and Family physician’s training curriculum for being sure about the quality of â€Å"primary care† as follows: (i) Clerkship: adding knowledge of burden global disease in the world such as: tuberculosis, malaria, Preventive care: vaccination; improving skills such as clinical making decision, communication. ii) Orientation: Adding knowledge of new   emerging infectious disease like SARS, non communicable diseases, traumatism care, HIV/AIDS; (iii) Residents: adding knowledge of prenatal care,   neonatal care,   chronic care, mental health care, adolescen t care;   Emergency care in disaster; improving skills such as: doing research and practice Emergency care in disaster, Behavioral care after disaster, Kangoroo’s program, Obs-Gyn care program; building up the relationship center care with WIN- WIN theory for both developed and developing countries to increase of cooperation and Team work. In addition, the cooperation among experts in different medical fields should be strengthened for teaching, managing, doing research to promote the concept â€Å"relationship center care† through many activities: * Establish Continue Medical Education, Patient’s clubs. * Build the bridge or integrate the teaching contents   in Family medicine   with the other specialties like Pediatrics, Traditional Medicine ( Oriental nutrition, Shiatsu), Cancerology (Palliative care), Multidiscipline (Disaster care, EBM, chronic care). Communication through Internet/ Video conference and Electronic medical: The WHO 2008 report emphasiz es the appropriate ‘use of information and communication technologies to improve access, quality and efficiency in primary care. The writer has made a small contribution to basic patient education (also known as doctor education) by the production of common patient handouts which are available for print out from General practitioners’ computers or for one page photocopying from the book ‘Patient Education’ (Murtagh J; 2008). Besides the residency training programs, on-going training courses to improve the competences and skills of Family physicians should be set for attributes considered most important for patient satisfaction (Stock Keister et al. , 2004a). Overall, people want their primary care doctor to meet five basic criteria: â€Å"to be their insurance plan, to be in a location that is convenient, to be able to schedule an appointment within a reasonable period of time, to have good communication skills, and to have a reasonable amount of experience in practice†. They especially want â€Å"a physician who listens to them, who takes the time to explain things to them, and who is able to effectively integrate their care† (Stock Keister et al. , 2004b, p. 2312). c. Others solutions and recommendations (i) Building an incentive scheme and financial supporting policy to Family physicians, especially whom working in remote and rural areas: The effectiveness of this model had been proved in many countries, particularly in Thailand and Malaysia where healthcare conditions are fairly similar to Vietnam. Contrarily, the recent P4P (Pay for Performance) policy of Thailand’s of Ministry of Health to replace the incentive scheme to Family physicians creates several problems to healthcare force and patients and is considered as a main cause leading the Family physicians moving to major cities. With relation between income and satisfaction, in an analysis of 33 specialties in U. S. , Leigh and associates (2002) found that physicians in high-income â€Å"procedural† specialties, such as Obs – Gyn, ENT, ophthalmology and orthopedics, were the most dissatisfied. Physicians in these specialties and those in internal medicine were more likely than family physicians to be dissatisfied with their careers. Among the specialty areas most satisfying was geriatrics. Because the population older than 65 years old in U. S. has doubled since 1960 and will double again by 2030, it is important to have sufficient primary care physician to care for them. The need for and the rewards of this type of practice must be communicated to students before they decide how to spend the rest of their professional lives. Patient satisfaction correlates strongly with physician satisfaction, and physicians satisfied with their careers are more likely to provide better health care than dissatisfied ones. Physician satisfaction is associated with quality of care, particularly as measured by patient satisfaction. The strongest factors associated with physician satisfaction are not personal income, but rather the ability to provide high-quality care to patients. Physicians are most satisfied with their practice when they can have an ongoing relationship with their patients, the freedom to make clinical decisions without financial conflicts of interest adequate time with patient and sufficient communication with specialist (DeVoe et al. , 2002). Landon& colleagues (2003) found that rather than declining income, the strongest predictor of decreasing satisfaction in practice is the loss of clinical autonomy. This includes the inability to obtain services for their patients, control their time with patients, and the freedom to provide high-quality care. ii) Compulsorily assigning General practitioners/ Family physicians to practice at local level hospitals, the servicing term at local level hospitals must be reasonable and acceptable. (iii) Improving facilitates of local level hospitals/clinic s, enforcing the lower level hospitals to implement modern technologies and quality control. This allows Family physicians to better serve patients as some achievements of Project 1816 of Vietnam Ministry of Health. (iv) Involving patients for private and family health care and prevention, structured information supporting treatment. (v) Improving the reputation of Family medicine and physicians in society through public media channels like television, newspaper.. etc, medical education programs and medical community. Even after the specialty is formally acknowledged by institutionalized medicine, family physicians have experienced a variety of negative responses from medical colleagues in other specialties. Carmichael (1978) perceived 3 stages in the reactions of those in medicine to Family medicine: first, the field was ignored; second, it was actively opposed; and then, family medicine is entering a third stage of possible co-optation by medicine. 6. Conclusion The weakness of Family medicine and insufficiency of family physicians cause many strategic consequences to the healthcare system in Vietnam. Their correction requires a long-term strategy to increase the quantity of Family physicians, quality of care, revise the residency training programs, improve its reputation in the society .. etc. In conclusion it seems appropriate to paraphrase Dr Robert Rakel in his keynote presentation to the 14th WONCA World Conference to reaffirm the Family medicine era in the contemporary medicine: â€Å"Regardless of how computer literate we are or how high our technology or whether the setting is urban or rural, good medical care in the future will continue to depend on patient care provided by a concerned and compassionate family physician. The physician will be governed by ethics, not economics, by a partnership with the patient, not politics; and by compassion and communication, and not by capitation. Good medical care in the future will depend, as it does now and always has, on the quality of our interaction with the patient† Dr Robert Rakel – 14th WONCA World Conference) REFERENCES 1. Alain J. Montegut, The Power of Primary Care for the Future of health care: Is Family Medicine the Answer? 1st International PHC Conference Doha, Qatar 1 – 4 November 2008 2. Bod enheimer et al. , 2009. Bodenheimer  T. ,  Grumbach  K. ,  Berenson  R. A. :  A lifeline for primary care. N Engl J Med  Ã‚  2009;  360:2693-2696. 3. Cogswell BE, Sussman MB, Family Medicine: A new Approach to Healthcare (Marriage & Family review, ISSN 0149-4929; v. 4, no. 1/2), The Haworth Press Inc. 1982. 4. Dang Van Phuoc : Plan to decrease workload of Central level hospitals 2012- 2020 – Vietnam Ministry of Health, 2012. 5. Didier L. Roles of Family medicine, Texbook of Family medicine for the co-operation between Liege University – Brussel and Vietnam, Medicine Publisher, 2009. 6. DeVoe et al. , 2002. DeVoe  J. ,  Fryer  G. E. ,  Hargraves  L. ,  et al:  Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care?. J  Fam Pract  Ã‚  2002;  51:223-228. 7. Gulliford, J Public Health Med 2002; 24:252-4, and personal communication 9/04. 8. Landon et al. , 2003. Landon  B. E. ,  Re schovsky  J. ,  Blumenthal  D. :  Changes in career satisfaction among primary care and specialist physicians, 1997–2001. JAMA  Ã‚  2003;  289:442-449. 9. Leigh et al. , 2002. Leigh  J. P. ,  Kravitz  R. L. ,  Schembri  M. ,  et al:  Physician career satisfaction across specialties. Arch Intern Med  Ã‚  2002;  162:1577-1584. 10. Murtagh J: The road to excellence. Australian doctor 3 2008, 46-8. 11. Murtagh J: Paradigms of Family medicine: bringing traditions with new concepts; meeting the challenge of being the good doctor from 2011, Asia Pacific Family Medicine, 2011, 10:9 12. Murtagh J: Patient education. 5 edition. Sydney: McGraw-Hill; 2008. 13. Pereira Gray DJ: Just a GP. J R Coll Gen Pract 1980, 30:231-239 14. Pham Le An, Integrate the issue of global health in FM curriculum: promising solution for improving the quality f Primary care in Hochiminh city, Vietnam  , Introducion FM concept: global healh, texbook of Family medicine, Vietnamese version, Medicine Publisher, 2009. 15. Pham Le An, Global health perspective in Vietnam, A â€Å"Train the Trainer’s Workshop†   WONCA   ASIAN PACIFIC Vietnam Ho Chi Minh city, 2008 16. Phillips and Starfield, 2004. Phillips  R. L. ,  Starfield  B. :  Why does a U. S. primary care physician workforce crisis matter?. Am Fam Physician  Ã‚  2004;  70:440-446. 17. Rakel RE: Family medicine-meeting new challenges. Australian Family Physician 1996, 25(9 Suppl 2):S91-6. 18. Rakel RE: The Family Physician, Textbook of Family Medicine, Eight Edition, Elsevier Saunders, 2011, pp4-15 19. Rivo et al. , 1994. Rivo  M. L. ,  Saultz  J. W. ,  Wartman  S. A.   et al:  Defining the generalist physician’s training. JAMA  Ã‚  1994;  271:1499-1504. 20. Smith et al. , 2002. Smith  P. C. ,  Westfall  J. M. ,  Nicholas  R. A. :  Primary care family physicians and 2 hospitalist models: comparison of outcomes, processes, and costs. J Fam Pract  Ã‚  2002;  51:1021-1027. 21. Starfield, 1994. Starfield  B. :  Is primary care essential?. Lancet  Ã‚  1994;  344:1129-1133. 22. Starfield, 2000. Starfield  B. :  Is U. S. hea lth really the best in the world?. JAMA  Ã‚  2000;  284:483-485. 23. Starfield, 2001. Starfield  B. :  New paradigms for quality in primary care. Br J Gen Pract  Ã‚  2001;  51:303-309. 24. Starfield et al. , 2002. Starfield  B. ,  Forrest  C. B. ,  Nutting  P. A.   et al:  Variability in physician referral decisions. J Am Board Fam Pract  Ã‚  2002;  15:473-480. 25. Starfield et al. , 2005. Starfield  B. ,  Shi  L. ,  Grover  A. ,  et al:  The effects of specialist supply on populations’ health: assessing the evidence. Health Aff (Millwood)  Ã‚  2005;  24:W5-97-W5-107 26. Stock Keister et al. , 2004a. Stock Keister  M. C. ,  Green  L. A. ,  Kahn  N. B. ,  et al:  What people want from their family physician. Am Fam Physician  Ã‚  2004;  69:2310. 27. Stock Keister et al. , 2004b. Stock Keister  M. C. ,  Green  L. A. ,  Kahn  N. B. ,  et al:  Few people in the United States can identify primary care physicians. Am Fam Physician  Ã‚  2004;  69:2312. 28. Susan JA, Vietnam’s Healthcare system: A Macroeconomic Perspective, Paper Prepared for the International Symposium on Health Care Systems in Asia Hitotsubashi University, Tokyo, 2005. 29. Vietnam Ministry of Health: Plan to decrease workload of Central level hospitals 2012- 2020, 2012. 30. Woolhandler et al. , 2003. Woolhandler  S. ,  Campbell  T. ,  Himmelstein  D. U. :  Costs of health care administration in the United States and Canada. N Engl J Med  Ã‚  2003;  349:768-775. 31. World Health Organisation: The World Health Report 2008: Primary Health Care now more than ever Geneva; 2008. 32. World Health Organisation: World Health Report 2009: Promoting health and development-closing the implement gap Geneva; 2009. -oOo-

Homework Essay

Chapter 5 1. Describe how we measure the clinical performance of an HCO as a whole? For example, can you aggregate good performance in cardiology and poor performance in obstetrics, and say â€Å"overall, performance is average†? It depends on how measurement is being done. If a scorecard is used, yes the performance could be aggregated. However, the book mentions moving the departments off the scorecard that do not need improvements and focusing on the departments that aren’t doing well or need improvement in certain areas. Scorecards are beneficial in showing overall performance but can also be evaluated to see which departments are not meeting or exceeding the benchmark. If measurement was on a department basis and one was not doing well, that department would need to focus on the developmental areas in order to say that performance is good. â€Å"Overall† means an average or an overview. It’s not specific to one department but an average of all. One could fail a nd others exceed in which â€Å"overall performance† would be â€Å"average.† Chapter 6 1. Describe how an institution can ensure that its medical staff plan is realistic? List the specific steps you think would be important, and which would make a reassuring checklist when presented to physicians and to the governing board. An institution needs to measure input and output to effectively staff the facility. Input can be measured by patient arrivals and appointment requests (request for care). Output can be measured by patients treated, cost per case, quality and access. The physician organization also assists in providing excellent care by recruiting and retaining physicians necessary to provide this care. Physician supply should remain open to leave and come as the community demand raises and lowers. However, it is more effective to be strategic in planning the staffing needs. Too big leaves physicians underworked. Too small leaves physicians ­Ã‚ ­ overworked. A medical staff plan should be implemented to protect physicians  against new competitors. 2. Medical staff leadership: Why should medical staff leadership be appointed by and accountable to the governing board, as opposed to being selected entirely by the medical staff or by the executive? To avoid tax situations, the board must remain nonphysicians (pg 205). Also the board must vote for what is in the best interest of the community. If there were several physicians on the board or the medical staff or executive appointed this, it would be considered a conflict of interest because it’d be harder for the medical staff to do what’s in the best interest of the community rather than what’s in the best interest of the physicians. 3. What is the goal of communication with physicians? How is that goal attained in large organizations? The intent of the communication network is to identify potential conflicts in advance, analyze and understand them (pg 205). PITs, surveys and organizational guidelines and processes are implemented to help resolve these issues. Bylaws are also set and used to describe rights and obligations of each party. They are also used to encourage negotiations and conflict resolution (pg 206).

South African Apartheid-Era Identity Numbers

South African Apartheid-Era Identity Numbers The South African Identity Number of the 1970s and 80s enshrined the Apartheid era ideal of racial registration. It was brought in to effect by the 1950  Population Registration Act  which identified four different racial groups: White, Coloured, Bantu (Black) and others. Over the next two decades, the racial classification of both the Coloured and other groups were extended until by the early 80s there was a total of nine different racial groups being identified. Black Land Act Over the same period, the Apartheid government introduced legislation creating independent homelands for Blacks, effectively making them aliens in their own country. The initial legislation for this actually dated back to before the introduction of Apartheid- the 1913  Black (or Natives) Land Act, which had created reserves in the Transvaal, Orange Free State, and Natal provinces. The Cape province was excluded because Blacks still had a limited franchise (entrenched in the South Africa Act which created the  Union) and which required a two-thirds majority in parliament to remove. Seven percent of the land area of South Africa was dedicated to roughly 67% of the population. With the 1951  Bantu Authorities Act  the Apartheid government lead the way for the establishment of territorial authorities in the reserves. The 1963  Transkei Constitution Act  gave the first of the reserves self-government, and with the 1970  Bantu Homelands Citizenship Act  and 1971  Bantu Homelands Constitution Act  the process was finally legalised. QwaQwa was proclaimed the second self-governing territory in 1974 and two years later, through the Republic of Transkei Constitution Act, the first of the homelands became independent. Racial Categories By the early 80s, through the creation of independent homelands (or  Bantustans), Blacks were no longer considered true citizens of the Republic. The remaining citizens of South Africa were classified according to eight categories: White, Cape Colored, Malay, Griqua, Chinese, Indian, Other Asian, and Other Colored. The South African Identity Number was 13 digits long. The first six digits gave the birth date of the holder (year, month, and date). The next four digits acted as a serial number to distinguish people born on the same day, and to differentiate between the sexes: digits 0000 to 4999 were for females, 5000 to 9999 for males. The eleventh digit indicated whether the holder was ​an SA citizen (0) or not (1)- the latter for foreigners who had rights of residency. The penultimate digit recorded race, according to the above list- from Whites (0) to Other Coloured (7). The final digit of the ID number was an arithmetical control (like the last digit on ISBN numbers). Post-Apartheid The racial criteria for identity numbers was removed by the 1986  Identification Act  (which also repealed the 1952  Blacks (Abolition of Passes and Co-ordination of Documents) Act, otherwise known as the Pass Law) whilst the 1986  Restoration of South African Citizenship Act  returned citizenship rights to its Black population.