Issues in Public Health Funding

Issues in Public Health Funding PUBLIC HEALTH FUNDING: SHIFTING THE PARADIGM Submitted by: Betsy Cook Aisha Essuman-Mensah William Flattery Lacresha Getter Edna Kavuma Joe Mosnier ISSUE Despite comparatively high levels of spending on healthcare, the health of the U.S. population continues to lag that of its counterparts (Alper, 2014). In this paper, we evaluate the current landscape of funding for public health initiatives, the lack of uniformity of financial accounting standards for public health spending, and our proposal to address the existing funding structures of the public health system. Our multi-faceted approach includes: Federal, state and local government funding through a tax on medical services, with an emphasis on developing predictable funding based on funding cost-effective, evidence-based interventions. Investment by the healthcare industry through accelerated payment reform that incentivizes initiatives in population health management. Increased contributions to NGOs working in the public health arena through provision of expanded tax credits for individual and corporate donations to these organizations. ASSESSMENT The U.S. faces an urgent need for fundamental structural reform of its public health funding. Current public health funding streams are highly erratic and generally inadequate, in part due to a â€Å"fixation† upon clinical spending (Teutsch et al., 2012). Therefore, while per capita spending on healthcare in the U.S. exceeds that of other wealthy countries, the U.S. continues to experience comparatively poor health outcomes (Teutsch, 2012). LITERATURE REVIEW Challenges in Current Funding Methods The federal government provides a significant portion of both state and local health public health spending. Federal agencies subsequently influence provision of public health services at the state and local levels (Ogden, 2012). In essence, by being a primary funder and policy driver, the federal government often substantially influences the priorities and policies used to implement health services at all levels (Ogden, 2012). Consequently, state and local health agencies are often confined to the directives set forth by the federal government, which can result in various distortions in expenditure and service provision. One example is the federal government’s sudden shift of attention and funding allocation at moments of acute concern regarding infectious disease crises, such as with SARS and the more recent Ebola outbreaks (Weintraub, 2014). Aside from federal influence, there is considerable variation in sources and the amount of public health spending at the state and local level (Ogden, Sellars, et al., 2012). Additionally, a reliance on inconsistent formula-based funding allocations often results in ineffective and inequitable public health spending. Funding formulas are often hampered by low-quality data, inconsistent calculation methods, and the complex political realities that ultimately shape allocations decisions (Honore, 2007). Challenges in Current Accounting Methods In a recent IOM Roundtable, David Kindig notes the need for a reallocation of spending away from ineffective interventions, and the parallel need for new strategic alignment of the interests of multiple sectors to find what he informally calls the â€Å"sweet spot† (Alper, 2014). Kindig notes that one of the main challenges is deciding how to spend the money (Alper, 2014). A significant barrier to deciding where to spend public health funding has been the historical lack of standardized financial accounting methods utilized in the public health sector. Honore et al. point out the relatively lack of financial transparency in public health and call for reforms including a uniform chart of accounts, uniform classification of expenses and revenues, creation of a professional public health financial managers association, and standardized electronic data reporting (Honore et al., 2007). Any funding organization making an investment in public health will increasingly require this greater transparency (Honore et al., 2007). Ogden et al. also calls for development of standardized accounting methods to facilitate comparisons across organizations (Ogden, Sellars, et al, 2012). Additionally, evidenced-based public health (EBPH), a practice currently encouraged of public health organizations, insists on cost-effective interventions (Brownson, 2009). One component of EBPH is economic evaluation. Until we have robust and uniform financial accounting standards, it will be difficult to evaluate the success of various healthcare initiatives. Even in the arena of government funding, there is an increasing demand for close financial accounting of funds allocated to public health departments (Levi, 2007). Such demands include a demonstration of how monies are being spent to support the core functions of public health, these being assessment, policy development, and assurance (Turnock, 2012). RECOMMENDATIONS To overcome the current problems with fragmented and declining revenue streams for public health, we propose an alternative approach specifically intended as a sustainable funding model sufficient to support core public health functions at appropriate levels. 1. Sustained and coordinated government funding. As noted above, current government funding is highly fragmented and dependent on a mix of local resources combined with federal funds that are often restricted to specific programming (Ogden, 2012). Like Kindig, we call for a move from â€Å"grants and short term appropriations† to a more coordinated effort across government departments based on a comprehensive, long range focused public health effort (Alper 2014). Diminishing government revenue can be addressed through a small tax on clinical healthcare services (IOM, 2012). If a sustained, dedicated revenue stream in the form of a clinical medical services tax can be achieved, we believe that the nation’s overall public health infrastructure can substantially improve population-based outcomes across the U.S. 2. Increased population health spending by the healthcare industry. Private, for-profit healthcare providers can play a major role in â€Å"transforming† their communities through a combination of health interventions (Alper, 2014). Gunderson notes it will require a shift from â€Å"reactive† spending to â€Å"proactive† spending (Alper, 2014). The current shift in basis for payment for medical care from episodic care to population â€Å"pay for performance† mechanisms has the potential to create the environment where healthcare systems see such community-based investments as financially attractive, perhaps even obligatory for their financial survival. However, the transition to â€Å"pay for performance† mechanisms presents several challenges. Slow pace of change, lack of experience by healthcare organizations in public health management, and threats to vital revenue for â€Å"critical access† organizations in resource poor communities all pose significant hurdles (Alper, 2014). A shift from medicalized spen ding to public health investment is critical, and progressive healthcare organizations can play a vital role in creating this awareness and facilitating and modeling transition steps. 3. Enhanced spending by NGOs in the public health arena. The IOM roundtable notes the success of community development strategies in improving health (Alper, 2014). Many of these efforts can be best carried out by NGOs or other organizations that already maintain high levels of financial transparency. NGOs also offer a nimbleness that is often lacking in the government bureaucracy due to their governance structures and financial transparency. Additionally, as James Hester has noted, such organizations can play the role of â€Å"integrator† (Alper, 2014). As such, these organizations can help to manage and coordinate revenue streams, capital requirements, community resources, and local health needs. However, in order to have adequate funding, specifically for those non-profit entities that depend largely on private donations, NGOs must have a reliable donor pool. In order to encourage donations to NGOs, we recommend passage of legislation authorizing enhanced tax credits for individuals and entities contributing to these entities. Th rough such a mechanism, NGOs will have the resources to take a leadership role alongside public health departments in developing, managing, and evaluating community-based public health interventions. CONCLUSION Despite rising levels of healthcare spending, the U.S. continues to fall behind in most measures of health (Teustsch, 2012). The U.S. risks falling further behind in health status unless there is a shift in focus from spending on medical interventions to spending on the well-documented determinants of health, including community, social, economic, and built environments (Teustsch, 2012). Such investments will ensure the continued economic growth and competitiveness of the US in the global economy (Teustsch, 2012). The historically fragmented and financially opaque public health system requires immediate and comprehensive reform. Effective reform will propel a shift from reactive illness-based spending to proactive community-based public health preventative investment. As discussions focused on this critical problem continue, we recommend implementation of the specific measures set out above. Works Cited Alper, J, Baciu, A., IOM Roundtable on Population Health Improvement. Financing Population Health Improvement: Workshop Summary. (2014). IOM. Brownson, R. C., Fielding, J. E., Maylahn, C. M. (2009). Evidence-based public health: a fundamental concept for public health practice. Annu Rev Public Health, 30, 175-201. Honore, P., Clarke, R., Mead, D., Menditto, S. (2007). Creating Financial Transparency in Public Health: Examining Best Practices of System Partners.Journal of Public Health Management and Practice,13(2), 121-129. IOM. Committee on Public health Strategies to Improve Health, Board on Population health and Public Health Practice. For the Publics Health: Investing in a Healthier Future. (2012). Washington, D.C.: The National Academies Press. Levi, J., Juliano, C., Richardson, M. (2007). Financing Public Health: Diminished Funding for Core Needs and State-by-State Variation in Support.Journal of Public Health Management and Practice,13(2), 97-102. Ogden, L. (2012). How Federalism Shapes Public health Financing, Policy, and Program Options.Journal of Public Health Management and Practice,18(4), 317-322. Ogden, L., Sellers, K., Sammartino, C., Buehler, J., Bernet, P. (2012). Funding Formulas for Public Health Allocations: Federal and State Strategies.Journal of Public Health Management and Practice,18(4), 309-316. Teutsch, S., Baciu, A., Mays, G., Getzen, T., Hansen, M., Geller, A. (2012). Wiser Investment for a Healthier Future.Journal of Public Health Management and Practice,18(4), 295-298. Turnock, B. J. (2012). Public Health: What it is and How it Works (Fifth ed.). Burlington, MA: Jones Bartlett Learning. Weintraub, K. (October 6, 2014). Ebola outbreak a wake-up call to the world. The Boston Globe. http://www.bostonglobe.com/lifestyle/health-wellness/2014/10/05/ebola-shows-how-global-public-health-has-become-everyone-concern/vc8R92VHmtpd4vZVbqzYEP/story.html. Retrieved November 25, 2014.

Ethics, Fairness, and Trust in Negotiations Essay

Discuss two of the following statements then respond to at least two of your classmates’ postings. Try to respond to students who picked different statements. * Discuss how skills in ethics, fairness, and trust can be a part of the negotiation process even though some negotiation tactics challenge those values. * Identify the Five Bases for Trust and explain why they are important in the negotiation process. Describe Kant’s Ethics of Principle and Mill’s Ethics of Consequences philosophies and discuss which theory you would be more incline to use in a negotiating situation. Kant’s and Mill’s philosophies are a means to identify ethical means to guide parties to a successful negotiation. They are two separate school of thoughts in ethics. Kant believes that moral rightness should overcome and minimize self-interest, feelings, or empirical fact. Kant’s moral principle is based on pure reason. He states that basic ethical principles aren’t â€Å"empirical† (from sense experience). Ethics gives necessary truths that hold for all rational beings. In other words feelings whether personal, rational or irrational or sentimental should not be involved in ethical reasoning. He believes that ethics based on reason is needed more than self-interest motivation because such motivation can lead to violation of duty. Such motives lessen our moral worth; the highest motive is to do our duty, not from ulterior motives, but just because it’s the right thing to do. Kant supreme moral principle is to act as if your action would become a universal law and to treat yourself and others as an end it itself not the means to an end (Gensler, 1998). On the other side, Mill’s philosophy is based on pure utilitarianism (self-interest). Utilitarianism says that the basic moral principle is that we should to do whatever promotes the greatest happiness of the greatest number. Mill equated happiness with pleasure. But not all pleasures have equal value; higher pleasures of the mind are better than lower pleasures of the body. Mill’s view is purely hedonistic in nature. The basic idea of his philosophy is that any intrinsic value is based on pleasure which equals  to happiness and we should all strive for it. There are however different values of pleasures in his view. The highest pleasures are more valuable than lower ones. For example, the pleasures of learning things and of helping others are more valuable than the pleasures of eating and drinking. We can decide which pleasures are more valuable by looking to the consensus of experienced observers. Utilitarianism says that actions are right if they promote the greatest happiness for the greatest number. This is the basic principle of ethics of Mill’s philosophy, and the foundation of morality. In applying the principle, the happiness of everyone is equal. We should all strive for our own individual happiness. So, as a group, we try to obtain the happiness of all in the group and this is the basic foundation of the utilitarian principle (Gensler, 1998). The two individual principles are equality attractive in the negotiation process and I can see the benefits of both of them. However, I believe that Kant had the right idea. If we are using either idea as a guide in the negotiation it is best to go for a more moralistic point of view than utilitarianism. I believe when we only think of self interests we lose sight of the true objective and purpose of the negotiation. Source Gensler, H.J. (1998). Ethics: A Contemporary Introduction. London and New York: Routledge. Retrieve online at http://www.jcu.edu/philosophy/gensler/index.htm. Discuss the Functionalist Model, Mutual Trust Principle, and the test for meeting procedural fairness of a negotiation. The Functionalist Model is about procedural fairness in a negotiation. The model refers to the bargaining as a voluntary process and the purpose is to reach an agreement. Also, the concept of the model refers to behaviors that threaten reaching an agreement are also threats to the purpose of the negotiation. In this the negotiation process is adversarial and bargaining tricks and tactics are used to gain information and advantages (Carrell, 2008). The Mutual Trust Principle refers to the procedural fairness in trust building in a negotiation. The idea is to build trust early in the beginning of the negation process. In other word to treat others as you would want to be treated. Your actions speak louder than word has a lasting effect on how you are perceived and how you perceived others. The appropriate behaviors in this principle to build trust is exhibits the same trust worthy attitude when you are gathering information about the other party by asking friends, associates, and contacts. It is appropriate and expected that you would make an unrealistically opening demand and hide your real position. It would be appropriate and expected behavior that you give an open impression of non-adversarial and confrontational. The misrepresentation of facts and lying in a negotiation are inappropriate behaviors. To falsely threaten or promise things with no ability to deliver and use confidential information by bribery is unfair and inappropriate (Carrell, 2008). The test for meeting procedural fairness of a negotiation is to ask yourself the following standard questions: * Reciprocity standard—would you want to be treated in this way? * Universality standard—would you advise others to behave this way? * Publicity standard—would you like to see the actions in the press? * Trusted friend standard—would you tell your friend of your actions? * Legacy standard—do you want to be remembered for acting in this way? Source Carrell, M.R. & Heavrin, C. (2008). Negotiating essentials: Theory, skills, and practices. Upper Saddle, NJ: Pearson Prentice Hall. ISBN-10: 978-0-13-186866-3

The Truth About Change - Free Essay Example

Sample details Pages: 4 Words: 1345 Downloads: 4 Date added: 2019/04/01 Category Society Essay Level High school Tags: Truth Essay Did you like this example? Humans strive for stability, so when faced with change, stability’s greatest threat, people shy away. Nevertheless, in order to succeed in a world where technology and beliefs are constantly evolving, one must be willing to change themselves. Published in 1975, E.L. Don’t waste time! Our writers will create an original "The Truth About Change" essay for you Create order Doctorow’s historical novel Ragtime traverses the line between history and fantasy, investigating the lives of many diverse characters: some who embrace change and others who do not. Tateh, a Jewish immigrant working to support his daughter, exchanges his life of destitution for one of prosperity by contributing to the rapidly expanding film industry. Mother, an upper class housewife in an era lacking many women’s rights, learns to manage her family and their company, while her husband, Father, a white middle class firework manufacturer, is on an expedition in the Arctic. Father, unlike Mother and Tateh, refuses to acknowledge that his family no longer needs his support in the way they once did and consequently loses all sense of purpose. Through the development of characters Tateh and Mother, whose adaptation to their changing situations leads to their success, and Father, whose failure to adapt leads to his downfall, E.L. Doctorow exposes the truth that one must eithe r welcome change as it is presented or be abandoned by society. Tateh’s transformation from a street peddler working in the slums of New York to a wealthy movie producer transpires because of his willingness to adjust throughout life. Tateh moves to Massachusetts to escape his horrid existence, but when his fellow mill workers go on strike and violence prevails, he flees the town, unintentionally landing in Philadelphia. After learning that the strikers won, he declares, â€Å"The I.W.W. has won. But what has it won? A few more pennies in wages†(131). Dissatisfied with this victory, Tateh â€Å"decides to leave his belongings to the landlord in Massachusetts†(131) and stay where his life has led him. Although this means he must begin his life anew, he chooses to reshape his life rather than return to a place that while familiar, will restrict his growth. Along with rejecting the labor movement, Tateh abandons his radical, socialist beliefs. Despite society’s opposition towards these beliefs, Tateh had such confidence i n the ideology that he served as president of the Socialist Artists’ Alliance. The change is his political ideology serves to demonstrate the extent to which he will travel to succeed in American society (King). Tateh’s willingness to desert a cause he once championed demonstrates the importance of making significant changes not just to one’s life, but to ones identity as well. Rather than merely look for a means to survive, Tateh strives to benefit from each new situation he encounters. After arriving in Philadelphia, Tateh sells the picture book he designed for his daughter to a novelty company he stumbles upon, earning himself â€Å"a boarding house in a good neighborhood a meal and a hot bath,†(133) moments after arriving penniless in this new state. Tateh designed his picture books for the pleasure of his daughter, but his encounter with the novelty company changes his perception of how his art can earn him a living. The picture book far far better than the silhouettes he used to make; nevertheless, he does not stop at these books. As literary critic Michelle Tokarczyk remarks, â€Å"Tateh transforms his future by manipulating them† into motion pictures. Innovation runs rampid in the era the novel takes place in, so Tateh continues to change his product as the technology of the time evolves until he has made himself a huge fortune. When r eflecting on his success, Tateh reveals that â€Å"his new existence thrilled him†¦ He felt he deserved his happiness. He’d constructed it without help† (258). With each change Tateh faces, he assesses his situation so that he not only acclimates to the change but benefits from it, demonstrating that change, if viewed positively, can reward its adversary. Mother’s ability to adapt in the absence of her husband and assume a role soley recognized as that of a man’s during the early twentieth century grants her a happiness she had not realized she lacked. While Father explores the Arctic, Mother takes over as head of the firework company and succeeds with such ease that all of the business’s â€Å"mysterious potency was dissipated and she saw it for the dreary unimaginative thing it was†(250). Mother once depended on her husband, but her triumph causes her to realize that her marriage has prohibited her growth; in fact, when Mother encounters Sarah, a young black girl whose failed attempt to abandon her daughter lands her in trouble with the police, Mother makes the executive decision to take responsibility of the girl. She stands by her decision â€Å"despite the best advice of the doctor and the remonstrations of the police†(71). The doctor and the policeman are two key symbols of white male authority , so by disregarding their advice, Mother acknowledges that her wisdom matches, if not overpowers, theirs, a notion she never would have considered before her husband voyaged to the Arctic (Ferrà ¡ndez San Miguel). Mother’s evolution into a woman who recognizes her own self worth allows her to discern what she wants in her life, rather than living to please others. Presented with a change in the structure of power within her family after Father’s return, Mother continues to expand her role, taking her well-being into her own hands instead of returning to her part as the quiet, hopeful housewife. Whereas before Father’s voyage, Mother viewed sex as a distasteful, but necessary duty to her husband, after his return she â€Å"was in some way not as vigorously modest as shed been. She took his gaze. She came to bed with her hair unbraided† (111). Faced with Father’s absence, Mother realizes that she had been living in a state of subservience and decides to change her standing in her relationship (Ferrà ¡ndez San Miguel). By changing her outlook on sex, Mother claims her sexuality and starts on the path to discovering what she wants for herself in life, which includes no longer waiting for her family â€Å"to discover a life of genius†(249). Instead, she decides to take her future into her own hands, making change s that increase her happiness. A few years after Father returns, he dies. However, Mother quickly adapts to the circumstances, marrying Tateh, whom she truly â€Å"loved to be with†(319). Mother’s ability to evolve as her circumstances change allows her to achieve a new sense of self and a feeling of happiness. Although Father realizes that his absence caused his role within his family to change, he disregards this knowledge and continues acting as the man his family no longer needs, causing him to feel alienated. Once the respected leader of his family, Father returns an outsider, treated â€Å"like a convalescent†(111) by his wife and his now competent son, whom after his return, Father â€Å"felt childlike beside†(113). Father sees that his family no longer depends on him, but rather than feel proud, he fears that he has lost his place. When Mother takes the initiative to change the decor in the dining room, â€Å"Father, sensitive to every change, found his appetite diminished†(154). His susceptibility to change harms him in every avenue of his life and limits his development, resulting in his death shortly after being deserted by his family and friends. In order for people to reach their full potential, they must acknowledge changes they need to make within themselves. However, many people would rather remain ignorant than face the difficulties of changing their persona. With the technological advancements of the twenty first century it has become even easier for people to ignore their faults and need to change. Hiding behind a screen allows people to adopt whatever persona pleases them, but this resource should act as a model for who people could become if they changed, not an escape from who they are. Doctorow’s intent remains relevant despite the era; people must welcome change to remain satisfied with their role in life.

Gender Segregation - 926 Words

Davis Anderson Sociology 3337 Prof. Korinek October 23, 2012 Group 7 Analysis of: Revisiting the Glass Escalator: The Case of Gender Segregation in a Female Dominated Occupation This critical examination and study, done by Karrie Ann Snyder and Adam Isaiah Green, dives into the data of a predominately women’s job, nursing, to find out if men really have a â€Å"glass escalator† when it comes to advancing up to top positions and dissects the notion of horizontal segregation. The glass escalator theory is one that assumes males in female dominated professions are pushed up the ladder to administrative and supervisory positions much easier and faster than women. Throughout the article, they explain the methods used to gather the data, both†¦show more content†¦When interviewed about why they chose their specialization, men seemed aware of the gender connotations of their job, while women rarely mentioned it as a factor. This is a direct cause of why segregation across different areas of work is much more prevalent than segregation through the administrative ranks. The name nurse often carries with it negative connotations in the eyes of m ales. It is inherently feminine in its perception and plays a large role in scaring men away or causing them concern about what others think and leading them into positions that are thought of as more manly. Nursing is unique in the wide range of specializations that it offers, and that may play a part as to why horizontal segregation is so widespread as opposed to vertical. Oftentimes males seek positions of prestige and in nursing those desires may be filled by working in masculine roles as opposed to higher-ranking positions that would typically validate success in other professions. From the data gathered and personal accounts reviewed, it seems that men chose positions thought of as more masculine based primarily on fulfilling the conceptions of gender identity. Financial interests and personal desires do have an effect, but it seems that sticking to the gender â€Å"rules† is the largest factor in determining the careers of practicing male nurses. The data in this study isShow MoreRelatedGender Segregation926 Words   |  4 Pages23, 2012 Group 7 Analysis of: Revisiting the Glass Escalator: The Case of Gender Segregation in a Female Dominated Occupation This critical examination and study, done by Karrie Ann Snyder and Adam Isaiah Green, dives into the data of a predominately women’s job, nursing, to find out if men really have a â€Å"glass escalator† when it comes to advancing up to top positions and dissects the notion of horizontal segregation. 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