Part-Time Job While Studying Essay

The modern world now provides students with the best condition for studying. Therefore, some people suppose that they need not to have a part-time job any more but try to focus on their study. On the other hand, the rest of them argue that a part-time job still plays an important role in forming the necessary experience for students. To the best of my knowledge, despite the current comfort in education, it is still essential that students should take part in a particular part-time job for many reasons. To begin with, many peoples present the reasons for the unnecessity of having a part-time job among students. The first point is that a part-time job can make students spend less time on their study, thereby harming their study result. Another reason is that the part-time job environment is often not professional and safe, which can put students at the risk of being defrauded. The final reason is that taking part in a part-time job will cause more pressure to students, consequently affecting badly their health. However, in my opinion, such reasons above are still one-sided and not so persuasive. Coming back to the first point above, we can agree that the completive world now makes students become more sensible that they used to be. In fact, most of the students know that their study in school must be the main means of providing them with a good future, not their part-time jobs. In the second reason presented above, the unsafe environment of part-time jobs, on one hand, maybe make students defrauded, on the other hand, give the students valuable experience about real life. Therefore, they will certain the more successful people in the future than the ones who do not participate in a part-time job. Finally, suffering from the part-time jobs for a certain time can help students find the best way of reconciling between their study and working. Surely they will know how to draw an effective schedule for their lives. Finally, in favor of the people arguing the necessity of having a part-time job, I can give some reasons for my point of view. To begin with, a part-time job will give students more experience about life which they cannot earn at school such as the skills of communication, how to be a confident person. This can help them become more mature and easier to be successful in future. The second reason is that students can widen their relationship by participating in a part-time job. In fact, the more friends they have, the more probably they will deal successfully with the obstacles in life. Last but not least, taking part in a part-time job can help students earn more to support their study. Consequently, they will be less dependent on their parents and believe more in their own ability. To sum up, it is quite essential that students should have a part-time job while studying. This will give them many valuable lessons which they cannot find in any academic school. In fact, we just study in school in the first twenty years of life, but we study in real life during the rest of our lifetime.

Cicero On Duty Essay

Cicero’s definition of duty is a term in which in this course, is far reached than what we would have ever thought duty would stand for. Defining duty can be said to be a commitment or obligation to someone or something that causes them to pursue a certain action. Duty is split into two parts which consist of dealing with what is the â€Å"supreme† good and second, practicing rules which are strictly regulated in all means of daily life. Another classification of duties are duties which are middle or complete. Complete duty is link to being what is â€Å"right†. Middle duty is the reasoning behind why has it been done. When Cicero writes about individual activism we consider the duties that are honorable and dishonorable. What is honorable or dishonorable? People’s spirits are often pulled between opposing opinions. The individual then has to see whether or not it will offer him an advantage in life. Cicero discusses the major principal thought on duty which is based on a conservative standpoint. The different forms of duty happened due to human nature. Civic duty takes different forms. Civic duty will always leads back to the people that live in the society. Questions asked is what do we owe? What can I do? Cicero writes how the nature of a person will influence his decisions based on what is the â€Å"honorable† thing to do at a certain time. A individual showing wisdom towards the publics concern is part of the action. Cicero uses a strong example when he speaks about promising to be at a appointment but not showing up due to someone close to you getting ill. He explains how not making the appointment would not be contrary to your duty because you abandoned what you promised. This shows your neighbor that your character can’t be trusted. The fellowship you keep with the community is a responsibility. Fellowship is so important to the form of civic duty according to cicero. He explains how one should be able to share, give advice, and cause no evil to their neighbor. Justice is the foundation of duty. Justice in a society emphasizes on the civic duty to ones state. As a citizen you should never find yourself on an omission state but to be contributing in honest forms towards society. Other principles is that of carrying a great spirit. It would help you have courage in your actions and for that reason you will hold honor towards yourself. When Cicero writes about the reasons for why people have duties towards the public sphere he believes that the individual is part of the community. He contributes it all the to belief of Stoicism. Aristotelian is another close source in which we can speak about duties, but Cicero’s true belief was that virtues is key to duty. Stoicism is the school of thought that holds the belief that the only way we can make sense of our own existence is by devoting ourselves to virtues. People who follow this pathway believe that the majority things of daily life are stuff we can’t control, but yet we can contribute our life to society in a better way. Honor is another reason why individuals choose certain choices that lead you to be seen as a noble person in your society. The wide picture is seen towards how the community sees the individuals actions according to the standards in which have been placed. It doesn’t seem like an individual would ever perform a duty if honor wasn’t the reward. An individual who doesn’t care for much pleasure would mostly likely seek out honor in the public sphere. In conclusion Cicero comes up with the belief that the main stance on duty should always be honor, because honor is the only thing that really brings out the obligations that we owe to ourselves and the society you live in.

Quantitative and Qualitative research (Dose clothes price influence Paper

Quantitative and Qualitative (Dose clothes price influence Cambridge EF student to purchase) - Research Paper Example Stating precisely, as per the recent trend, the clothing price is getting cheaper than the previous trends. Correspondingly, in order to examine this notion, the students from the EF studies of Cambridge region will be observed in this study as subjects to answer the question as to whether they are being influenced by the clothing price. The prime objective of the study is to analyse the recent prices of clothes in the area of Cambridge region in contrast with the trend observed around the globe. Besides, the study will also evaluate the extent to which, the recent clothing price has been affecting the purchasing power of EF students from the Cambridge region, based on the hypothesis developed below. In the recent scenario, dressing style has become an important matter for the young generation, which is considered as a mechanism of imprinting one’s personality and superiority from their counterparts in the society. Observably, a large number of clothing or textiles companies have been paying more attention towards delivering quality services providing fashionable clothes to its consumers, based on their tastes and preferences. According to Allwood & et. al. (2006), the modern day clothing materials are getting cheaper, increasing scope for innovation in the industry dimensions. Notably, the modern trend clothing style is recognised as more fashionable rather than expensive and diverse, which indicates the perception of its users to differentiate themselves from others within the society. Allwood & et. al. (2006) further elaborated that in the year of 2000, aggregated consumer expenditure amounted at around US$1 trillion that also indicates the expanding boundaries of the industry. Above all, it signifies the changing perceptions and notions amid the consumers of the clothing industry, which on a wider realm, may exhibit the transformations witnessed within

Theories of Crime Causation Unit1 DB Essay Example | Topics and Well Written Essays - 250 words

Theories of Crime Causation Unit1 DB - Essay Example Other social factors that affect the individual determine recidivism of the individual (James 2003). Therefore, it is imperative to consider these factors in the rehabilitation process to ensure its success. Although rehabilitation works, the effectiveness of this method does not quite do away with recidivism, and it becomes necessary to adopt measures that prevent the occurrence of crime. Prevention of crime is a concept that works effectively in the reduction of crime. The police oversee the task of prevention of crime, and as such, they must focus on prevention of crime. This implies, therefore, that the main objective of the police is the protection of innocent lives from criminals and prevention of crimes against these innocent individuals. However, in the execution of this duty the police officers should operate within the law and at the same time ensure the protection of the innocent (Gordon 1998). Additionally, the police officers should also handle the criminals in a manner that conforms to the provisions of law relating to such individuals. This situation puts the police in a tough position and implies that, in the balance between protecting the innocent and upholding the law, the police must act prudently. Thus, the police officers should protect the innocent while upholding the

Organisational disasters occur as a result of ineffective decision Essay

Organisational disasters occur as a result of ineffective decision making. Assess the validity of this claim with reference to at least two different organisational disasters - Essay Example The need for continuous monitoring at every level of management is especially important because more than one level of management can be involved. Organisational disasters can be explained as a breakdown caused by organisational processes or procedures. Organisational disasters can be caused by conscious organisational activities and administrative evil, normal accident and safety and risk. The rapid growth of technology and the dramatically falling cost of computing capability means that more and more aspects of managerial planning and decision making can be assisted by information technology provided, of course, that the information system is developed in accordance with properly defined objectives and principles. Thus, it does not guarantee safety and effective planning so important for modern organisations. Following Edwards and Wajcman (2005) organisational disasters occur when â€Å"things go wrong† (p. 145). The researchers add that Apart from its inherent importance, the issue of mistakes and errors is valuable for several reasons. First, it is rarely addressed in studies of organisations. Not only is it absent from many standard textbooks, but it is also not discussed in a volume aiming to lay out the key approaches to strategy, even though overcoming errors might be seen as central to strategy (p. 146). Another important element of the effective performance is decision-making process. Decision-making influences organisational performance and future growth. Among all the operations of a business, it is decision making and planning of a strategic nature which makes the greatest demands for information on the external environment. It requires ongoing monitoring for developments which would change the position of the business in relation to its market or other environments, and ad hoc research for particular purposes. Decision-making has a great impact on performance because it determines the best practices and allows a

Company Law Essay Example | Topics and Well Written Essays - 1000 words - 4

Company Law - Essay Example This is because ethical policies and codes of practice may only be seen as guidelines and at any given time, a company or a member of the board may do what is more beneficial to them rather than to do what is most ethical. If policies were enough to manage corporate governance, there would be no need for governments and regulatory bodies to make the laws necessary to keep corporate and personal greed in check. For instance, environmental degradation is a very important topic for the world today and governments as well as non governmental organisations are looking at various ways and means by which they can help the environment (Green, 2005). However, corporations often have to be forced through regulations and laws to minimize their impact on the environment (Schulte, 2006). Had a code of practice which encourages social responsibility been enough, no board member of a company could have agreed to a policy of the company which damages the environment regardless of the profits that could be made. It is only when the profits of a company are at risk when it can be made to apply the rules of good corporate governance. For example, Apple Inc. was forced to change the packaging for its famous iPod since Greenpeace objected to the amount of waste material that came with the iPod. Fearing angry customers, Apple altered the packaging to make environmentally friendly (Planque, 2006) When Steve Jobs (the CEO of the company) launched a new version of the product he focused on the subject and said, â€Å"Weve got some new packaging for the new Nano as well. And its 52% less volume. This turns out to be an environmentally great thing. Because it dramatically reduces the amount of fossil fuels we have to spend to move these things around the planet (Planque, 2006, Pg. 1)†. Of course, Apple could have changed the packaging and made it environmentally friendly from the start but only a threat of lost sales moved it to do so.

Apple Stock Research Paper Example | Topics and Well Written Essays - 3750 words

Apple Stock - Research Paper Example According to the study the industry in which Apple operates in can be characterized into external features using Michael Porter’s five forces framework. The industry has barriers to entry due to the significant capital requirements needed to enter. The degree of competition that the industry faces also limits entry of newcomers and the brand identity that each player in the industry creates bars new entrants since they would struggle for any significant market share due to their lack of any brand identity.From this paper it is clear that  there is the constant threat of substitutes that the company faces due to the higher prices that the company imposes on its products as compared to its competitors. Generally, Apple products are highly priced than other similar products in the market, therefore there is that threat that consumers might opt to go for a lower priced commodity from Apple’s rivals. The threat of substitutes is also created due to the nature of the compan y business which is a closed ecosystem and is therefore difficult to switch to any other form of business. There is also the supplier power that Apple as a corporation holds. The company always creates quality products making the company have the power to bargain for a higher price for their products in relation to their competitors.  Apple Inc. is one of the most valuable companies in the world and much of its success is attributed to the sustainable competitive advantage it has created over the years.

Coursework Ecotourism Example | Topics and Well Written Essays - 1500 words

Ecotourism - Coursework Example Similarly, another objective of ecotourism is to improve the ecological state of the visited sites, i.e. improving life in marine and life in seas and oceans (Fennell & Dowling, 2003). This report is assessing the ecotourism activity associated to dolphins, which are one of the species that are most challenged due to natural resources’ depletion. Concerning to dolphins’ ecology, the argument stands out that due to human-derived impact such as the environmental pollution, eutrophication, and exploitation of the seas and oceans, dolphin’s life is under threat. The objective of this report is to find out that how ecotourism is facilitating the ecological conservation of dolphins. What challenges ecologists face while they tour areas populated with dolphins will be answered in this report. The subject of ecotourism will be further be studied and comprehended in this report. What are Dolphins? In order to understand ecotourism with respect to dolphins, it is primarily important to understand dolphins in their nature. Therefore, this section is describing dolphins, their behavior, their ecology and their living patterns in changing water conditions (Viddi & Ribeiro, 2004). Dolphins are marine mammals mostly categorized in the families of porpoises and whales. Dolphins fall in 17 genera and are discovered in almost 40 different species (Garrod & Wilson, 2003). Dolphins are warm-blooded and precisely keep the companionship and friendly behavior with humans. Almost 34 dolphins are considered as marine dolphins while the remaining 6 species are popularly known as river dolphins (Viddi & Ribeiro, 2004). Dolphins are sharp. They are smart and considered as the most intelligent mammals. Their intelligence makes them distinctive among all the mammals (Garrod & Wilson, 2003). Moreover, their response and action carry the great remark by researchers and ecologists (The Dolphin Institute, 2002). The contemporary studies assert that dolphins are mostly found in oceans and seas. They live in blue waters and also found in sea aquatic regions. Dolphins are mostly in groups (Garrod & Wilson, 2003). The ecological researchers describe that dolphins are familiar with group patterns and group environments. In this way, dolphins live in a team format. They catch food collaboratively and interact with the environment and humans in the synergetic way. All these characteristics describe dolphins as unique and distinctive mammals (Gale, 2001). Dolphins and Ecotourism The Reynolds-Braithwaite Model In order to identify effects which dolphins have in their environments, the Reynolds-Braithwaite Model can be brought into significant application. This model is effectively applied in ecotourism practices, especially when tours are arranged to study dolphins and their natural instinct (Fennell, 2007). The model consists of two sections in which one section asserts the effects on wildlife (dolphins) and the other displays the intensity of experience on w ildlife. Below is how the model demonstrates two different sections: (Fennell, 2007) This model asserts intensity of experience on dolphins. The model assists eco-tourists on surveying a particular destination of dolphins. It comes out as a supportive demonstrating tool for researchers investigating wildlife (Fennell, 2007). Risks on Dolphins’ Conservation Applying the Reynolds-Brai

How Smoking in Public Places Is Harmful Essay Example for Free

How Smoking in Public Places Is Harmful Essay Many studies and surveys have been researched and prove rather or not smoking in public places can be harmful to others. Studies have proven that smoking is hazardous to our health. When the person who smokes is active that makes the person that’s near him and inhale the smoke passive smokers However, people have been smoking for many years smoking draws people in by using some type’s advertisement to draw them to smoking. Smoking is not a good habit smoking causes serious health issue to the smokers and also the people around them that inhale the smoke. Cigarette also contains ammonia and other carbons which could cause other respiratory infection and lung cancer. The particles from smoke may cause cancers, emphysema and other side affects. Blood vessels raise blood pressure and give the effects the nervous system, which can lead to reproductive disorders in the long run. Smoking in public places can be harmful to the heart by banding smoking in public places you significantly reduce the risk of heart attacks among the young people and young people and nonsmokers. Studies have proven that by banning smoking in public places that rate of people having heart attacks have been reduced by 26 percent per year. Studies have really proven that smoking in public places can be harmful to our health in many ways even breathing in low doses of cigarette smoke can increase one’s risk of heart attack. Second hand smoke really increases the chance o heart attacks. Smoking in public places is not only harmful for people that don’t smoke nut harmful, to young children and older people. Second hand smoke is extremely harmful to older people and young children. Smoking can be dangerous and deadly rather it’s first hand or second hand smoke the laws banning smoking might convince some people to quit smoking. In conclusion smoking in the public really causes bad health issues. Heart attacks, strokes and other health problem. Smoking cigarettes can be deadly. Cigarettes are known as the silently killer. Smoking should be banned in some public places to help prevent heart attacks and other health issues. Studies have researched and shown how smoking in public places can be harmful to your health.

Fast food restaurant Essay Example for Free

Fast food restaurant Essay A fast food restaurant is on every corner, but is actually good for you? Fast food became popular in the early 1900’s but it didn’t just take off. Fast food has made quite a journey in its development opening opportunities along the way. It has its advantages and disadvantages but being aware of them is very important. Fast food has made a huge impact on our nation’s health and economy. How was fast food developed? Burgers made at fairs, carnivals, and events were known as low quality. It took America a while to warm up to the idea of fast food. Many people mistakenly assume McDonalds was the first fast food chain but it was not. In the 18th century the convenience of eating away from home was becoming popular. As a result, White Castle was the first chain beginning in Wichita, Kansas. To make the idea of eating away from home more appealing they built their restaurants to show the customers the food being prepared. White Castle’s reputation for well-cooked burgers spread nationwide, making it easier for other fast food restaurants to move in. The McDonald brothers opened their redesigned restaurant in 1948. Soon after, Taco Bell and Burger King opened in the 1950’s and Wendy’s in 1969. Even though McDonalds is the name of fast food it has made a bad reputation in other countries because of its exaggerated marketing to children and unhealthy ingredients. Obviously, it took time for the United States to begin trusting fast food. Fast food can be hurtful to our bodies and the environment. The effects impact both children and adults. Within the food, the lack of some nutrients like Vitamin B and Omega 3 Fatty-Acids causes a person to become unhappy. This unhappiness leads to further problems like depression. Another major problem is the fatty foods sold in fast food restaurants cause a higher risk for Alzheimer’s. In 2009 the University of Berkley did a study that stated that the closer you live to fast food the higher the risk of problems with obesity. Obesity has swept this nation strongly and is one of the most impactful health problems today. Fast foods campaign directly towards children and tempt them with toys and playgrounds. Children obesity rate has tripled in the last 30 years alone as a result. Fast food has also contributed to our planet in a negative way. Livestrong. com states â€Å"To make 1 lb. of hamburger, for example, it takes 16 lbs. of grains and up to 2,500 gallons of water. † The New Community Project says if the people of the world ate more plant-based food we would be able to give food and clean water to the people who don’t have access now. Eating fast food often can be hurtful towards the body and the environment. After many complaints, the fast food industry is finally addressing the health problems. In 1965, the first Subway store was opened with its original title Pete’s Subway. Subway has addressed the issues of unhealthy living with their new spokesperson Jared Fogle who lost 245 lbs. after eating subway for a year. He began being shown in commercials and ads telling people his story. Subway then started adding the amount of calories in specific ingredients to the menu. They also started a new list to the menu called Fresh Fit that includes healthy options for every meal. Many fast food chains caught on to this idea and started showing healthier options and adding calorie counts to their menus. The fast food industry has only begun creating a healthier lifestyle option for people. The fast food industry hit this nation by storm. It has its advantages but do they outweigh the consequences? People of this nation need to watch how much fast food one consumes. Fast food can be good or bad, it all depends on what people choose. Cites Disadvantages of Fast Foods. LIVESTRONG. COM. N. p. , n. d. Web. 12 Sept. 2013. How Fast Food Works. HowStuffWorks. N. p. , n. d. Web. 12 Sept. 2013. Ashley Bruce 9/12/13

Current Trends In Hardware Platforms Information Technology Essay

Current Trends In Hardware Platforms Information Technology Essay The Infrastructure is one of the vital components in business strategy. If a bank wants to provide good customer service then they should adopt the best technologies that are available. The success of an organization lies with the Infrastructure development. The Infrastructure involves both the hardware and software platforms that are necessary for the operation of an organization. Causes for change in Infrastructures Cost of computing services and software is rising High customer expectations Integration of data across platforms Current trends in hardware platforms There are basically five trends in hardware platforms in recent years Integration of Computing and Telecommunications Platforms High rate of computation via network Integration of telephone and internet High computing power Grid Computing Cost saving on large infrastructures Smaller computer are connected to form a grid Increase the agility of organizations High speed of computing Cloud Computing Cost Saving as no capital investment is needed High speed computing Data transfer is quick Business Agility of organizations Autonomic Computing Develop systems that can automatically download updates Protect themselves from hackers and intruders Recover themselves in case of failure Virtualization and Multi-core Processors Both reduces power consumption Virtualization Accessing computing resources in multiple ways irrespective of geographical location and physical configuration. Multi-core Processors Use multi-core processors to reduce power consumption and heat. Current trends in software platforms Linux and the open-source software movement Linux is one of the most widely used open source software program Linux is supported by almost all platforms like HP, IBM, Intel, Dell, Sun etc. Linux is a open software and can be customized according to the needs of the company. Linux runs on all major hardware platforms mainframes, servers, and clients Java Programming language that is independent of the operating system and hardware processor. Java virtual machine has been defined. Java is compatible with any hardware Java applet has been employed when an object moves or input is required for the user. Leading interactive programming language available for the Web is Java. Software for enterprise integration The usage of enterprise-wide software systems by firms is an important trend in last few years. The goal is to achieve an integrated firm-wide information environment, reduce cost, increase reliability, to adopt business best practices which are captured by the software. AJAX, Mashups and Web-based software applications Ajax (Asynchronous JavaScript and XML) is a Web development tools used for creating interactive Web applications. Mashup It is a Web application that combines data or functionality from more than one source. Software outsourcing It is the prewritten software developed by a software company It helps the organizations from developing their own softwares. Mobile Platform The growth of telecom industry especially in mobile sector has been incredible over last few years. The service providers upgraded the mobile networks with next-Generation services like 3G, WAP and GPRS. The banks are trying to capitalize this growth in the telecom sector and provide the services to the customers through mobile. The main advantage of mobile banking over the Internet banking is that it offers Anywhere Anytime Banking. Customers can check their accounts, transfer funds, balance statements etc during travel without the access to a computer. The limitations of Internet Banking are overcome in mobile banking since it requires only a mobile which can be accessed by people of developing countries also. Mobile Banking Business Models The models of mobile banking are classified into three based on the relationship with the end-customers. They are Bank-focused model Bank-led model Non Bank-led model Mobile Banking Services The various services offered by the bank through mobile are listed below. Account Information Balance statement and checking account history Insurance policy management Checking the terms of fixed deposits Minimum balance alerts Pension plan management Payments Transfers Domestic and international fund transfers. Various bill payments Mobile recharging Payments of different products brought via e-bay, Amazon etc. Investments Alerts and notifications about various portfolios from stock market Assist in investments on stock market and mutual funds. Support Cheque book and card requests Provisions to register complaints through mobile Status of insurance coverage, credits etc ATM and Branch locator Content Services General alerts like weather. News etc Technologies Used in Mobile Banking Interactive Voice Response (IVR) In Interactive Voice Response (IVR) a pre-assigned number is specified to the customers by the bank. In IVR, when a customer make to a call to this number he will be acknowledged by a pre-recorded message. The customer can choose from the menu options specified in the electronic message according to his requirements. There are some limitations for the mobile banking through IVR IVR is expensive compared to data transfer via SMS or WAP Can be used for Enquiry Based Services only Short Messaging Service (SMS) The most popular technology used in Mobile Banking to provide services to customers is Short Messaging Service (SMS). The bank will provide the necessary information to the customers in reply to a service command to a pre-specific number send by the customer. The advantages of SMS are Cheaper compared to IVR Anywhere Anytime Banking Works across all service providers The major limitation of SMS is regarding the security of the contents. Wireless Access Protocol (WAP) In WAP concept the customers access the WAP sites maintained by the bank through the WAP compatible browser on their mobile phones. The advantage of WAP concept is that WAP sites offer the general form based interface Effectively provide security The disadvantage of WAP is dependency on speed of network connection and handset limitation. Standalone Mobile Client Applications This concept is used to provide complex banking transactions like trading in the stock market, securities etc. The advantages of this concept are Can be easily personalized in accordance with the density of the user interface Provides ample security Provide reliable channel for communication. The disadvantages are Several different combinations may prevent support of different devices, operating system etc Inconsistent performance due to differing handset capabilities Advantages of Mobile Banking Cost saving It helps Banks as well as service providers to achieve growth Banks will be able to provide good services to customers like reminding the customers on due dates of insurance, loan repayment dates etc Anywhere Anytime Banking Can be used over vast geographical area Need fewer numbers of employees to provide the services for the consumers. The mobile banking is expected to grow at a rapid rate. The online users of banking are expected to change to mobile banking. The number of mobile banking users is expected to grow to 50-100 million by 2016. The security of mobile banking is a major cause of worry. If the concerns of the customers are addressed properly, then mobile banking will be fully adopted by customers in future. Grid Computing The basic idea of Grid computing is that the computers are connected as a grid and the software running in the grid gives more priority to local users, but when they become idle these computers are used over the grid. In Grid computing the computers over the internet is connected using middleware permitting them to operate as a virtual whole. In Grid computing we use a distributed set of data centre rather than a single centralized data centre. The computers across the globe share resources for computation of large amount of data. If an organization having large numbers of computer, then a cluster is formed by connecting all computers. One main computer called front-end computer is connected to the grid through network. The remaining computers in the cluster is called back-end computer which is connected with front-end computer only. IBM is considered to be the leader in Grid computing. The IBM Grid data centres are compatible with all operating systems like Unix, Linux and Windows. The primary objectives of Grid Computing are Collective processing power Providing remote access to IT resources Advantages of Adopting Grid Computing Scalability If more capacity is required, add more computers to the grid. Economical handling No need of large IT infrastructures like Servers No need of experts to manage IT resources Price will be based on consumption. Grid computation allows effective utilization of resources. Redundancy and recovery Grid environments are much more modular and dont have single points of failure. If any failure occurs, there are large numbers of resources to take the task. Grid computing allows execution of large task by splitting into small pieces and executes them in different machines Grid computation allows parallel execution of a task Disadvantages of Adopting Grid Computing Internet Dependency Need fast internet connection Security Data storage in grid computation is liable for attack from intruders and hackers. It is difficult to manage so many computers in the Grid. There is unavailability of good middleware which hinders the implementation of grid computing. Licensing across many servers may make it prohibitive for some apps The Grid computation is not a new concept. The Grip computation has been used by many institutions to perform complex computations. The Grid computing offers efficient, quick, reliable and standard based solutions for the problems faced by Banks in this competitive environment. The Grid computation will help the Banks to provide services to the customers quickly. The distributed nature of grid computing is transparent to the customers for evaluation. If the security issue associated with the Grid computing is solved then the Grid computing can be used in the banking sector. Cloud Computing The cloud computing is the one of the most popular technology available in business. By 2015, the cloud computing services is expected to grow to $160 billion from existing $36 billion. The cloud computing provides number of services such as account operating, insurance services and loans etc. The cloud computing is customer-centric and flexible business model which will help the banks to gain maximum profit. The cloud computing will help the banks to deliver the services to the customers quickly. The idea behind cloud computing is that the data of the organization is stored in data centers located within the organization or datacenter provided by the cloud providers like Amazon. Cloud computing is divided into three Infrastructure as a service (IaaS) Share the infrastructure between several users. Database as a service (DaaS) Datas of many users is stored in single data base. Software as a service (SaaS) The services are given to the users on monthly subscription rather than buying the license by individuals. It has many advantages like simplicity in installation and maintenance, cost saving etc. There are four types of clouds used Private cloud Built within companys data centre and distributed to the internal business user through virtual communication, communications services etc. To meet the service requirements the components can be expanded and contracted. It permits more control to the organization, but does not support sharing of resources. Public cloud In public cloud the organizations operate the applications from a date centre which is provided by the third party. The servers, infrastructure and the network required for the operation of applications is provided by the third party. Community cloud Cloud is controlled and shared by multiple organizations having similar interest. Hybrid cloud In hybrid cloud features of both the internal private and external public clouds are combined. Advantages of Adopting Cloud Computing Scalability Capacity of the platform can be expanded or contracted according to the requirement. Cost Saving No capital investment is needed No need of IT infrastructure No need of experts to look servers etc Pricing is based on the consumption Less operational cost Business Agility Allows organizations to react quickly to market conditions Cloud computing is flexible High computing power Data transfer is faster Rapid innovations Built-in Disaster Recovery Back-up Sites Provides high level of redundancy Device Location Independence Enable customers to access the system from anywhere Its Greener Low power consumption Greater use of resources Disadvantages of Adopting Cloud Computing Security Data storage in cloud is insecure Data Location Privacy Different privacy and data management laws be relevant in different nations Internet Dependency, Performance Latency Dependency on internet Latency on the Internet is highly inconsistent and volatile Availability Service Levels Potential for down-time if the system isnt available for use Current Enterprise Applications Cant Be Migrated Easily Difficult to change existing arrangement to cloud computing The cloud computing is an evolving concept and it has many advantages and disadvantages. The cloud services will help the organizations like banks to provide services quickly at cheaper rates. I will also help them to provide the customers with 365*7*24 access to the services. So it is upon each individual organization to decide whether they implement cloud computing technology or not. Factors Affecting IT Infrastructure Network Economics There is a central difference between the old and new economies: the old industrial economy was driven by economies of scale; the new information economy is driven by economics of networks. (Carl Shapiro and Hal R. Varian, 1999) Declining Communication Cost The customers will be benefited if more networks enter into the market. If more competition takes place in the networking field the service providers will be forced to reduce the cost as well provides better service. Consider the case of Bharath Sanchar Nigam Limited (BSNL), the cost of calls was very high when BSNL alone enjoyed the monopoly of the network. But when more firms enter the telecom industry BSNL was forced to decrease the cost and increase the service provided to the customers. To improve the services given to the customers advancement in technology is necessary. They used new technologies like 3G to provide better services to the customers. Improving Technology Standards The network providers must upgrade the platform by adopting new technologies like mobile banking, grid computing and cloud computing which will help the service providers to improve the performance. Limited packages might benefit consumers. But network owner should not be able to bar services that allow competitive package offerings. For example, preferential caching by the network for an affiliated content provider might be o.k., but barring access for a 3rd party provider of caching services should raise concerns

Keeping Peace and Freedom :: Politics Political Freedom Essays

Keeping Peace and Freedom George Bush who is the President of the United States of America came and visited our small town of Flagstaff in September of 2002. As a leader of our country, he reminds the Americans that we should be grateful for our freedom. Through contextualizing, structure, and rhetorical appeals, he gets through to his listeners by reminding us all, that keeping peace and freedom is not an easy job to do. He tells us how lucky we are to have freedom, and what we have to do to keep our â€Å"homeland† safe for our children of today. He speaks on behalf of his people, and what he will do to keep his people safe from our enemies who â€Å"hate† us, because we choose to be free! As President, he is sworn to protect his people, and to keep everything in order in our country. He travels the world to try and promote peace among us and other countries. In this speech that was given by the President, he is speaking to everyone. The General Public, Professionals, Students, and every other citizen. He speaks of freedom and how to protect our â€Å"homeland†. He states â€Å"the enemies hate us because we have freedom†. (P. #3). As Americans we have the freedom to live where we want to, and how we want to. Most of all we have the â€Å"Freedom of Speech†. We voice our opinions when we feel it is necessary, without being punished by the government. In America, we stand together as one nation, to keep peace and freedom! Identifying the structure of Bush’s speech is ways to keep peace and freedom among everyone. In order to keep our freedom, we need to work together to keep our enemies out. He incorporates on how to eliminate all the â€Å"bad guys† one by one, so they will not hurt us again. Bush points out three main reasons to keep peace and freedom; 1.) Protecting our homeland! 2.) Hunting down the enemies. 3.) Preventing the killers from hurting America again. Protecting our homeland is a very difficult job to do, but it can be done when our people come together and fight for our nation.

Pueblo Indian Religion in the Early 20th Century Essay -- Essay Papers

Pueblo Indian Religion in the Early 20th Century The Pueblo Indians religious history is different than the average Christian religion history. Their religious beliefs are based on the creation of life. The persons seen as the creators of life are the centrality and the basis of their religion. In the early 1900’s these Indians were looked upon in different lights. White man compared the Pueblo rituals and religious routines with his own. Pueblo religious beliefs, practices and social forms were criticized, scrutinized and misunderstood by white Christian American settlers. The major religious practice and worship of the Pueblo Indians involved ritual dances. White men attempted to stop these Puebloan ritualistic dances because they did not meet his own religious standards and this happened before the Indians had a chance to explain or define what their dances really stood for. Women played a significant role in Puebloan ritual dances and religious A brief description of the Pueblo Indian culture and religion are needed to get a full understanding of why their dances were misinterpreted by white settlers and why the Indians were judged and treated in such an unjust way. Pueblo Indians lived in Arizona and New Mexico and had a very different culture religiously than the white man. White religious history shows us that women were not seen, in European and new American culture, as not being significant to religious practices. In the Pueblo religion, however the woman was regarded in a different light. They rarely practiced in religious rituals but were the center of their people’s religion. Pueblos had rituals that were performed exclusively by men, and there, these men imitated women’s reproductive pow... ... for their religious beliefs and cultural values. People’s religious beliefs and practices all need to be protected from harm and negative influence like a child needs care from his mother. The Pueblo Indians should be looked at as an example of how people should not be treated. This way, hopefully we won’t make the same mistake twice. We all have an obligation to know all the facts and the whole truth about something before we start to reject it. If the white people in the early 20th century had taken the time to understand the meaning of these dances they may not have been so quick to judge and may have stood back and reflected on their own ways of living. Work Cited Young Jane. "Women in Western Puebloan Society". Journal of American Folklore. 100.398(1987): 436-445. Jacobs D. Margaret. "Making Savages of us all". Frontiers. 17.3(1983): 178-209.

Online Education Essay

Every parent’s dream is to influence their children with life skills that will guide them to success in the future. In most cases, parents usually work full time jobs to achieve extra income to save for their children college costs. A college education could very well be that â€Å"cherry on top of the ice cream† for parents, and give them a moment to relax and finally take a breather. Today we find young adults with jobs working as hard their parents once did. This made it difficult to balance both work and school for them. In some instances, parents are usually the child’s first role model and teach them to set the standard for a good foundation of direction and determination. Students have been finding different methods to make it work by balancing out their work and school schedules. For example, working various schedules has been difficult, to include, morning, midday or twilight shifts just to add school, in their schedule. The burden in juggling work, school and personal time resulted in school taking a back seat and leaving no room to attend a traditional classroom. Distance learning has opened the door to the education community, businesses and private companies in many ways to assist those by introducing classroom instruction via online. Online education has boomed the past few years and has given individuals the chance to further their education. Priorities have once again changed, and the percentage of online courses taken has risen. Nonetheless, there is still argument whether a learner can obtain the information online, vice receiving proper classroom education. The goal of this paper is to address the benefits of distance learning are to identify the values, soundness and impact of online education. The future of online education has already impacted us in some way. Can one recall ever reading anything off your computer, smart phone or tablet? That is right! Believe it or not one has been educating themselves via the internet already. The tools are there and why not take advantage of a higher education with a college and/or university. In the article, Tom Snyder stated that, â€Å"lifelong learning must now be a part of everyone’s career plan†. I could not agree more with that statement. Web-based programs are on a rise and to educate oneself in an online environment is a significant benefit. There is always online training that your job requires one to complete for career advancement, without having a web based education one will not be able to get the required training needed for promotion. Online education is similar to what web-based training has to offer. It has the same goal in pushing out the information to such student, and it primarily depends on what the student is willing to learn. For students to have success while taking an online course, they should be determine and motivated. Even though online education is a self paced class, one can get overwhelmed and fall behind quickly. Instructors are answering questions online when students may have a problem. They will have to become more involved with the students by interacting on a one on one basis vice the classroom setting. The traditional classroom will always be there, and some may prefer it, but online learning has many benefits that cannot get passed up. In the Marine Corps, its main focal point is to be tactfully and technically proficient in their everyday duties. In the article, Samuel Ellis captures the big picture and identifies importance of being vigilant around your surroundings and what to do during an incident involving an active shooter. A key point that Brad Plumer wrote in February was that, â€Å"there have been 43 mass shootings in 25 states over the past four years – or nearly one per month†. The Marine Corps took notice, and it was not too long that something had to get done. Marine net is a distance learning tool that allows Marines, civilian employees and contractors the ability to gain and attain information via online education. According to Pete Russett, director of Mission Assurance Branch, â€Å"The shooting at Fort Hood and other similar tragedies led to this training†. Although this requisite requires your full attention to improve your experience on procedures for active shooters, it also assures that we can be familiar with the procedures of an active shooter. To train the number of Marines and civilians in a short amount of time would have taken long in a face to face classroom. However, Marine net bridged that gap and has established the ability to push out information and instruct everyone in a timely manner. Some may refer to online education as â€Å"false education† by not receiving the proper education in a tradition classroom. The article, Online Education May Transform Higher Ed, Brian Burnsed wanted to let the reader know that online education is happening throughout all colleges and universities and not leaving anytime soon. There were interesting facts that shook the online education movement. For example, change is constant and never-ending with innovations making it easier for students to access the internet for online courses. According to Matthew Tabor’s article, Louis Soares said, â€Å"A disruptive innovation always starts out at a lower quality,† he says. â€Å"[But], if you take that for-profit energy out of higher education, online [education] would not have grown the way it has in the last 10 years. † There has been an increase of student enrollment for online programs at these institutes. In the past, one was able to receive an associates and/or bachelors degree at smaller institutions that were strictly online courses. The bigger named universities and colleges have taken notice and started to implement newer online programs for potential students. This strategy ensured that students were, in fact, choosing these recognized institutes for online education. In Brian Burnsheds’ article, Richard Garrett, managing director at research firm, said, â€Å"We’re at the beginning of elite schools starting to take online seriously†. The increase of mobile technology has jumped start the revolution of online education. Students are far more familiar with computers that ever before. There are many changes that would have to be developed to create an online program that assists the instructor and teaches the student at the same time. Will there have to be personnel changes? Would the institute hire online only Professors? These are some of the factors to creating an effective online program, but the need of online education has increased and must be solved. At the end of the day, there are more positives than negatives for adding more online courses; it is just inevitable that students will take an online course sometime in the near future. Online education has come a long way to make it easier for students to achieve a higher education. It can be time consuming and beneficial at the same time. for the individual that is organized, determined, and motivated to self educate themselves. Many are skeptical that an instructor is not teaching, but just pushing information over the internet to the course. It is the responsibility of the student to ask questions; to improve his online learning experience. The rising demand for online courses will continue to climb and be as effective as or better than a traditional classroom. Though, it can all change with the intentions the institution has with the visualization and authenticity of their online education programs.

Personal Branding Plan Paper Essay

My professional career is composed of nearly fifteen years in the business world. During these fifteen years I have gained experience and a wealth of knowledge in the fields of sales, marketing, data entry, customer service, and training and development. I have worked in a few industries and during my tenure have learned the skills needed to successfully complete my tasks, in addition I have made observations that allow me to uniquely apply solutions that build efficiency and profitability for any organization. I started in customer service and my eagerness to learn more about the company and my role within it, let me to other positions such as sales, then finance, then corporate accounts and finally a position with Training and Development that has me currently working as an Assistant Manager. I have learned to connect with coworkers and clients in both a call center and face-to-face environment. In addition to customer care I have learned the ins and out of working in the business world to include meeting strict guidelines and producing results even when all the desired resources may not be available. I have learned negotiation tactics beneficially to all parties involved and creating ultimate value for the client whether that be a customer, your employer or a colleague. My experience has yielded positive results and satisfied clients culminating in my confidence that I would be an asset to any company and vice versa. A few of the companies I would like to work for include Southwest Airlines, the local School District, and Capital Group. At the top of my list, at this point in my life, would be Southwest Airlines. Not only are they ranked a wonderful employer but the perks of free flights for myself and loved ones would be excellent especially since all my relatives live out of town. I believe my experience would be greatly utilized at Southwest and we could mutually help on e another improve. I could bring my plethora of skills to their workforce, and in return for my hard work, they would reward me with the ability to see  family I haven’t seen in over a decade. Considering we are a family of five this saves considerable money and would be a great motivator to stay long term. Another company of great interest for me would be working for Capital Group, a leading group focused on delivering superior results to investors and financial institutions worldwide. This company not only provides great pay to their employees but benefits include generous amounts placed in a savings account for their employees by the employer. Also, although it is very important considering pension plans are a thing of the past; I would love to learn more about investing and mutual funds, and 401K. This company would allow me the privilege of learning something I have recently found interest in and I in turn could provide my expertise to assist and enhance in any way possible. Lastly, I would be greatly interested in working for the local school district mainly to get a bird’s eye view of the system especially now that my children are a part of it. Also, a great benefit to me would be having the same days off as my children when it comes to vacations and school holidays so we can be together as a family and I wouldn’t have to incur childcare fees while they are out of school. My expertise in many areas would be benefit to the School system because I can see things from a fresh perspective and offer viable alternatives to enhance the system for all involved. The best method for contacting the companies mentioned above would be submitting my resume online. In order to engage and influence the hiring decision, I must ensure my resume has areas that stand out to identify me as a good if not better fit than most. Because each company is unique I need to ensure I personalize my resume to best suit the needs of the desired company and position. Once I secure an interview I will present myself in the best light possible and showcase my talents and abilities in a manner that will display why I would be a great fit for this company and why hiring me would be mutually beneficial.

Health Financing in India

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