The Borzoi College Reader, Seventh Edition Essay

The Borzoi College Reader, Seventh Edition - Essay Example As matter of fact, the multiple reasons of immigration, assumed to be as many as the immigrants themselves, fall under similar themes that determine the immigrant’s life and how they are treated by the natives. Poverty has triggered a significant percentage of immigration. The poor move from places with low endowment of resource to seek better life’s in other places. However, no matter how promising these new places are, they don’t guarantee immigrants full satisfaction. Immigrants have continued to live filthy lives despite being in high status location. Mankind has developed a capitalistic nature, with every individual struggling to maximize his self-satisfaction. Literally, no one cares about the immigrants but instead take advantage of their vulnerability to attain self-development. Native humiliate immigrants; enslave them following the fact that, they are their financial supporters. This mistreatment corrupts he immigrants mind, creating a negative attitude towards the new environment. Racism in US has evolved, developed and even worsened due to immigration of black Africans to the whites’ territories in search for better hosting. The intercultural interaction br ings confusion, the definition of satisfaction is altered and hence most immigrants have remained in these cruel and anti-social environments so long as they receive some financial compensation. Good life, fair treatment and kindness and other social norms are no longer a priority and immigrants adapt cruelty. To quote â€Å"if we lived in Canada we could play outdoors every day in the sun†¦ sun is bad for you. Everything our parents said was good is bad†(298). Regions differ, socially and economically. Economic and social reasons significantly influence immigration. People move to acquire better healthcare, better education, and access auxiliary services as well security. The impact is

Erikson’s Time Line Essay Example for Free

Erikson’s Time Line Essay The aspect of psychology mainly studies the behavioral characteristics and personality of each individual in relation to their motivation, actual manifestations in terms of their actions, traits, perception, reasoning and others. In this concern, the science of psychology uses numerous approaches and concepts in its exploration of the human field in disseminating and explaining the significant and influential factors to the development of individuality and personality complex. Relative to the actual concern, the field of psychology also take the backward approach wherein it explains the background of each action and decision of each individual influential to their arrival to that certain point including the relationship of previous experiences, childhood factors, and other relevant issues. However, influential in the general pursuit of the study of psychology is the approach of gradually exploring the human development through disseminating the person’s life into progressive stages. In this concern, the concept of Erikson’s time line becomes a significant concept offering understanding towards a person’s personality and behavior. According to Erikson’s time line, each individual passes through each life-stage virtues as he or she age in life wherein the person’s behavior and personality develop as he or she contemplates over specific stage contrast. In each stage, a person must assess two different virtues relative to the age and level of his or her life determining how the person mature towards reaching the next level and proceed through life development. On assessing the personal journey of the author of this paper based on this time line, it likely appears that this author is within the fidelity stage wherein he is dominantly contemplating with the concept of identity and role confusion. In this particular stage, the person is still determining the path of which to pursue in life relative to the determination of his or her dominant identity on social and career matters. This is largely true in the author of this paper of which, he is still experimenting and deciding on the path of his passion, motivation, and determination. Mostly, the pressure of determining the person’s life conclusion gives the most hindrance in this stage of which is likewise true for the author of this paper. In addition, the challenge of finding the suitable and effective model from which to relate ones decision in this stage is also a crucial matter towards conquering this stage. Indeed, the author of this paper is within this stage of choosing the best position and the proper direction for his life which will likely determine his career and maturity development into becoming a successful adult in the future. Bibliography Dr. Boeree, C. George (2006). Erik Erikson. Personality Theories. http://webspace.ship.edu/cgboer/erikson.html. May 3, 2008

Essay --

Liselle Mason is in trouble four weeks she ignored the changes in her body and tried to forget her recent relationship with Oscar Price., her moody classmate at Buford high but when Lissele’s clothes stop fitting, and her brother notices her growing belly , she panics because she doesn’t know what she is going to do and how she is going to tell her mother that she’s pregnant all she does is hide it for four months and act like nothing is wrong until at lunch one afternoon Liselle got so lightheaded and fainted because she was either dehydrated or didn’t eat . But the problem was she did not because she was to stubborn and shocked to really commit and say that she is pregnant she was rushed to the clinic and the nurse said to her and her mother â€Å"honey? you were hungry you did not eat here? Drink some water and have some crackers† her mother replied saying â€Å" It’s ok honey we are going to get to the bottom of this and find out wh y are you like this or what cause this† Liselle replied saying â€Å"NO mom it’s fine I’m ok seriously I’m just tired and need some sleep I’ll be better in the ...

African Americans jazz Essay

Many believe that jazz is a music that African Americans played together with the Creole musicians during the 19th century in New Orleans, Louisiana in United States that bind the race together, black and white Americans. This is also considered as the ancient and most distinguished musical genres in North America and known as â€Å"America’s classical music. † Based from the quote of Gerald Early, a lecturer and a writer of African – American studies, he emphasizes that America will be known from three things: in the Constitution, sports (baseball), and in jazz music, since these are the most captivating things that they developed. Jazz is a type of lyricism that reflects on the Great American promise and expresses hope for freedom in slavery. It is also illustrated by the exceptional attribute of collective improvisation and should be performed with the right feelings about it. According to Louis Armstrong if you will ask, you’ll never know. He discovers the secret behind the jazz music, that’s why he became known as one of the successful musicians and leading stars in the whole world. The early jazz musicians create a great impact to the life of many as they change their point of view towards music. Although, jazz music is originated from the black, who are considered outsider but living in America, wherein they use this as a passage to be accepted in the society, still America truly owns this music. I prove it accurate because the New Orleans jazz musicians improve, develop, and patronize this music until the whole world has known it. One more thing, jazz has a big role to the history of America. This music becomes the expression of freedom because way back in 1970, it played a major role in the life of African American culture. Their longing for freedom is emphasized as they sing. I also believe that jazz eliminates the discrimination between the white and black people, that’s why I strongly agree that jazz belongs to America because the whole history of this country is the song itself. The history of jazz is deeply rooted in America and until now the musical tradition lives here. Works Cited The Importance of Jazz in American Culture | Jazz & More† http://jazz. learnhub. com/lesson/6809-the-importance-of-jazz-in-american-culture#ixzz0ESyZePQV&A The Importance of Jazz in American Culture http://jazz. learnhub. com/lesson/6809-the-importance-of-jazz-in-american- culture#ixzz0ET3vi6Uc&A A History of Jazz http://www. historyjazz. com/ The History of Jazz Music http://meltingpot. fortunecity. com/zaire/721/introframe. htm Jazz Music http://www. smallsjazz. com/

Issues Facing Prison Service

I consider the major challenges facing the prison service over the next 5 years, are preventing the introduction of drugs into prisons and managing prisoners with drug problems. Drug finds in prison doubled over the last 5 years, i. e. approximately 6 drugs finds per day in Scottish Prisons. 69% of the prison population report drug use compared to 8% in the community. Research has identified defined routes into prison. The main routes being visits, mail, prisoners on admission, over the wall, prison staff and concealed in clothing sent in.These routes are organised and concealed by individuals using illicit mobile phones, which are free from monitoring and provide real time direction. The prison service has the difficult task of allowing prisoners’ access to their families in decent humane surroundings, whilst at the same time preventing the introduction of drugs into the prison. Some prisoners` apply pressure on their friends and family to introduce drugs at visits; this may be done reluctantly and has serious consequences for the drug mule if he or she is caught.Basic tools such as observation, intelligence, CCTV out with the visit area and x-ray equipment can disrupt this practice, however, is not wholly effective. Items concealed in mail and include clothing sent in through the postal service, are well known to prison staff who routinely x-ray all items. This practice is risky for the small amount of drugs that can be concealed in these items. The searching constraints on prisoners on reception from court who have drugs concealed in body orifices is a difficult practice to tackle and can involve sizeable amounts of drugs being brought in through this route.Packages thrown over prison walls during exercise periods have become a profitable route of introduction. Prison staffs are advised not to intervene during this highly populated and sensitive period, but to monitor and deal with the recipients after the event; this allows the package to be secreted before intervention. Corrupt prison staff, for a variety of reasons i. e. debt, pressure or blackmail, introduce drugs, money mobile phones etc into the prisons. This relatively safe route is extremely problematic as the quantities involved are dependent on the reasons, nerve and desire of the corrupt staff member.For those participating in drug use in prison, there is a financial and health cost. Limited supply and high demand result in inflated prices. The debt incurred is paid for through a variety of means i. e. through canteen purchases, payments from families outside, selling or trading their own belongings or trading services i. e. inflicting violence on a nominated individual or acting as a drug runner, collecting debts or distributing drugs. The health costs are those associated with drug use i. e. lood-borne viruses from sharing equipment, anxiety, depression, paranoia, weight loss and malnutrition. Reducing drug introduction and managing drug users, are different sides o f the same coin and cannot work in isolation. These drug markets are associated with violence and intimidation, continued drug use in prison will increase the chances of dependent drug use when released. It is generally regarded that the take-up of treatment services in prison is correlated to the availability of drugs within the area.Increased security measures without adequate drug treatment programmes could be problematic. A robust clinical person centred detoxification scheme coupled with investment in a Counselling, Assessment, Referral, Advice and Throughcare service (CARAT) have shown to have a positive impact in drug use reduction. Drug free blocks, coupled with voluntary drug testing, have also shown to significantly reduce drug use amongst the population. Enhanced regimes which include employment and greater privileges have also proven successful.My recommendations to reduce the introduction of drugs into prisons and to manage prisoners with drug problems are as follows; * Nominate a Drug Strategy co-ordinator whose key role is to give equal weight to drug treatment and supply reduction measures within the establishment. * Have dedicated Drug Supply Reduction Teams. Motivated teams produce better results than less interested teams. * Improved liaison with local police, important for tackling all routes of external supply and should be included in the local prison drug strategy. Established prisons should move the prisoners to exercise areas away from prison walls. New builds should be designed to protect the exercise yard away from prison walls. * Security in and around the visit areas should be enhanced by the use of passive drug dogs, on site CCTV and trained motivated dedicated Drug Supply Reduction Teams. * Literature for visitors and prisoners on the impact, consequences and penalties of drug use and supply should be displayed and available for perusal. Passive drug dogs should be used in the searching of prisoner’s property, mail and acc ommodation area as a matter of course. * Cultivate a greater awareness amongst staff of the use and importance of intelligence reporting and feeding this into the National Intelligence Model. * Where possible block mobile phone signals, however the use of the Body Orifice Scanner System (BOSS) Chair should be used in all searches to detect plastic and metal. Identification and tracking of vulnerable staff should be addressed by the Drug Strategy Co-ordinator in collaboration with local police. * All prisons should have a person centred clinical detoxification scheme with recognition of the potential for misdirection and misuse of prescribed intervention. * Follow up and aftercare is as important as pharmaceutical detoxification, CARAT services with investment in staff is crucial to the effectiveness of work undertaken. Links and referral to Throughcare Addiction Services (TAS) will ensure continuity of treatment and care on release. Voluntary Testing Programmes provide support and i ncentives for drug users to remain drug free, resources should be allocated to continue the service. With skilful co-ordinated intervention, the reduction in drugs being introduced into prison will result in an increase in drug users seeking intervention. The challenge is to constantly review and adapt strategies to block new routes of introduction and to offer alternatives and support to those who wish to remain drug free.

United States Essay Example

United States Essay Example United States Essay United States Essay The United States enacted an embargo on Cuba in 1960; cutting off all ties with Cuba in an attempt to overthrow Fidel Castro. President Eisenhower ordered a complete stoppage of United States exports to Cuba The United States policy on Cuba proved counter-productive and negatively impacted the Cuban citizens. The embargo moved Cuba towards an oppressive government and helped Castro justify his oppression. The United States intended for the embargo against Cuba to further benefit Cuba as a country and lead Cuba more towards a democratic government.Instead this embargo forced Cuba towards a more communist government causing much more destruction than anticipated by the United States. President Eisenhower developed a plan to overthrow the Cuban President, Fidel Castro, when he determined the embargo ineffective. President Eisenhower disclosed his intention to eliminate Castro by either armed force or assassination. The tension between the United States and Cuba heightened when it became known that President Eisenhower planned to overthrow Fidel Castro. The United States entered into Southern Cuba to takeover the government by armed force.This invasion came to be known as the Bay of Pigs. The Cuban government was unaware of the exact date the exile force would land but Castro expected the imminent attack. The Bay of Pigs Invasion happened on April 17 through the 19 in 1961. A United States ship carrying all the weapons and ammunition intended for the invasion, sunk on the first day. The unsuccessful Bay of Pigs Invasion created more hostility between the United States and Cuba. After the Bay of Pigs invasion the United States pressured its allies to reduce their commerce with Cuba, in hopes of forcing Castro into submission.The Bay of Pigs Fiasco primarily caused the Soviet Union’s involvement with Cuba. The United States’ inability to make decisive decisions regarding government policies with Cuba encouraged the Soviet Union to exert more power over Cuba. The United States failure to decisively act led the Soviets to believe that their country’s economic and military involvement with Cuba would not endanger United States and Soviet relations. â€Å"The single most important event encouraging and accelerating Soviet involvement in Cuba was the Bay of Pigs Invasion. Some of Castro’s advisors wrote that he openly traded United States dominance for Soviet dominance. The embargo on Cuba significantly damaged the Cuban citizens. The embargo restricted Cubans from traveling to the United States and limited the number of United States citizens allowed to enter into Cuba. The embargo considerably impacted Cuban’s daily lives including access to basic needs such as food, health care and education. The embargo also resulted in political oppression. Nancy Pelosi reiterated this when she argued against House Resolution 927.Ms. Pelosi stated, â€Å" H. R. 927 tightens the embargo against Cuba- an embargo which has only resulted in inadequate access to medicine, to food, to healthcare, to education, and to development, for the Cuban people. It has not had an impact on Castro. It has not contributed to an open society. It has not opened any doors to freedom. † The embargo on Cuba negatively affected the daily lives of the Cuban people. The Cuban people suffered because of the embargo that ultimately provided no sizeable gain for the United States.The United States failed to overthrow Fidel Castro but continued to impose the embargo that caused pain and destruction for the Cuban citizens. Castro’s willingness to accept Soviet domination allowed Cuba to rely on the Soviets for economic support. Prior to the collapse of the Soviet Union in 1991, Cuba relied heavily on the Soviet’s for the majority of their imported food. When the Soviet Union fell, Cuba lost billions of dollars in economic aid. The United States knew of Cuba’s dire economic state resulting from the fall of t he Soviet Union.Yet, the United States continued ignoring the desperate state of the Cuban people hoping that the depravity of food would force a citizen revolt against Fidel Castro. The United States used food as a weapon instead of lifting the embargo and providing the aid the Cuban society desperately needed. During a subcommittee meeting about consumer affairs, Stephen Weber president of the Maryland Farm Bureau stated, â€Å" We support immediate resumption of normal trading relations with Cuba†¦ In short, food should not be used as a weapon†¦U. S. rade policy has demonstrated that more than forty years of isolationism has failed to produce a democratic reform. † The United States failed to act and in consequently the Cuban people suffered not Castro. The United States should have allowed the importation of wheat and corn in to Cuba. Helping the Cubans would have had no damaging consequences for the United States. In 1961 the Cuban government embarked on a camp aign to eradicate illiteracy. Cuba, once one of the most literate countries in the world, slowly lost their prominent lead in their advancing education system.Teacher shortages in Cuban schools made the educational process difficult. The students lacked updated books with the newly accepted ideas. Had the United States lifted the embargo on Cuba, the access to the educational tools available in the United States would have further benefited the country. Students from the United States are finding that it is extremely difficult for them to get a license to travel to Cuba for educational purposes. Cuban’s are not allowed to travel to the United States thus making it extremely difficult for them to gain intellectual freedom.The embargo limits the knowledge and growth of education between Americans and Cubans. The embargo made it almost impossible for Cubans to broaden their horizons and become familiarly with the new advances in science and technology. There is little freedom of expression in Cuba because the government controls the media. Cubans are in danger of imprisonment if they speak out against the government. The Cuban constitution allows citizens freedom of speech as long as it adheres to the objectives of a socialist society.Dissidents are prohibited from voicing their opinion about the government. If Cubans tried pursuing their individual rights imprisonment would result. Public disorder or alarming the citizens of the rights Cubans lack resulted in imprisonment. Fidel Castro justified the oppression of the Cuban citizens by declaring that any dissent against the Cuban government actually supported the United States in their attempt to overthrow Castro. â€Å" The Cuban government’s justification for oppression can be largely encapsulated in three words: the United States. The United States continued to let the government’s harsh feelings about Castro control political decision-making instead of helping citizens and political pris oners held in violation of their basic human rights. Although many political leaders in the United States are against the embargo, the United States continued to pass legislation strengthening the embargo against Cuba. The Cuban Liberty and Solidarity Act adopted on March 6, 1996 by the United States House of Representatives intensified the United States embargo against Cuba, seeking international sanctions against Castro’s government.This resolution also proposed a plan to support a transitional democratic government for Cuba. Although this bill passed, political leaders did not agree with the sanctions placed against Cuba. One of these leaders spoke candidly about her opinions on the United States embargo against Cuba. Representative Nancy Pelosi stated, â€Å"I oppose H. R. 927 [Cuban Liberty and Democratic Solidarity Act of 1995]†¦ because the embargo has not contributed in any way to increased freedom and democratization in Cuba. Rather it has only made life hard f or the Cuban people.Fidel Castro is still in power and suffering no consequences from this embargo. The people of Cuba, however, suffer daily because of it. † The political leaders throughout the world disagreed with the United States and their position on the Cuban embargo. The United Nations, in October 1997, voted to support a nonbinding resolution encouraging the Americans to end the embargo against Cuba. One hundred and forty three countries supported this resolution, while only two voted with the United States those being, Israel and Uzbekistan. Most all of the countries in the World opposed the United States embargo on Cuba.Even with most of countries in the World encouraging the Unites States to lift the embargo, the United States stayed committed to its vendetta against Fidel Castro. On February 19 2008, Fidel Castro stepped down as President of Cuba. He renounced his title to his brother, Raul Castro. The United States should have taken******************** this as an opportunity to lift the embargo, and renew its political and economic ties with Cuba. The United States should have acknowledged and acted on the majority of the world’s opinion and should have given up its vendetta against Fidel Castro.This would have been a perfect time for the United Stated to open the doors to a more democratic society by providing aid instead of an embargo that had not produced any results except oppression of the people in the last half of century. The embargo placed on Cuba was intended to weaken the power that Fidel Castro had over Cuba and eventually force him to resign. Thus helping Cuba move towards a more democratic government. Instead the embargo on Cuba only strengthened Castro’s power and lead Cuba more towards a communist government.The embargo has stripped the Cubans of basic rights that could be available to them if the embargo was lifted. The intention was to help the Cuban people escape Castro’s reign but instead it forced t hem to endure years of hardships. United States Essay Example United States Essay United States Essay Before I came to the United States four years ago, I lived with my family in Japan. We were what you could call an average middle class family with equally average adherence to tradition.Japan, though recognized to be one of the worlds most modern cities, has an outlook that is very much rooted in the traditions.   We as children were brought up to be polite, respectful and avoid unnecessary and unpleasant confrontation.   Hard work and pride in our identity and culture as Japanese were the virtues we grew up with.My mother and widowed paternal grandmother who lived with us, were very traditional Japanese wives who stayed at home and believed that their duties lay in looking after their family. While the number of Japanese women opting for careers and joining the ranks of the employed have grown since the olden days, my mother always said taking care of us and her husband were the only roles she wanted to ever have.My father on the other hand was a true hard worker. I remember hi m getting up every 5:00 am to do his meditation before breakfast, then leave promptly by 7:30 for work.   He was also the head of the family so every now and then, a cousin or perhaps an uncle would come to our house and seek his advice over steaming cups of sake (hot rice wine). While the family system in Japan has evolved from the formerly strict family community, most Japanese families still designate and recognize heads of the family.   And though he doesnt say it out loud, I know that being the head of the family meant a great deal to my father the same way being able to provide for us through the salary he earned at his job.Coming to the United States has shown me the vast differences between Western and Oriental culture and society.   For instance, American women seem to be more independent and expressive of their opinions. The culture here is a bit louder than what I grew up with and the vast number of people of different races made me a little anxious as to how I will adjust and fit in.I think the feelings I had on first setting out for the unknown is somewhat similar to the people in the cases handled in Social Work.   While I am not saying that I fully understand how a person might feel after the shock of losing a leg or perhaps having problems brought about by age, gender or social class, I believe I have an idea of that feeling of fear of the unknown.On coming here, I left behind a place where everything was comfortable and familiar. Back home, I knew everyone and had a sense of familiarity with the daily life.   I believe losing that comfortable feeling of knowing ones surroundings and having a semblance of control over what one does would be a terrible thing to happen.For example, in the case of a man who has lived his life doing a job in which he has muchpride then suddenly finds himself handicapped and retired before he planned to do so. My father who takes so much pride in providing for his family and feeling a sense of accomplishme nt each day would probably be my best reference.   I know he would absolutely hate the feeling of helplessness that being handicapped for the first time can do.   As the patriarch of the family, this helplessness and loss of control will be very hard on him.If I were faced with a case similar to this, I would know that consolation and comfort will simply not be enough.   I must base my program on his primary need to still feel useful and have some sort of control so as to get his cooperation.It is not uncommon to come across cases where the people involved find it hard to accept modern or innovative ideas in terms of their rehabilitation.   My mother for instance, being the traditional Japanese mom that she is, will hate to be told to go out and enjoy other peoples company.   While for some people, treatment and readjustment works well in social groups like bingo or social clubs, my mother would feel very shy and that would make her even more uncomfortable.   A program t hat includes domestic work and hobbies like gardening and sewing will probably suit her more effectively.One thing Ive noticed is that very few people really like to be told what is good for them whether they are young or old.   I remember my paternal grandmother who, despite being told by doctors and family alike to stop working so hard because of her age and often achy arthritis, would still insist on sweeping the porch and doing her own laundry.   Often she would get angry if anyone of us tried to do these things for her.   She would often say I am just old, not crippled.  Ã‚  Ã‚   She experienced humble beginnings and so she learned to do things by and for herself.I believe that is something every caseworker should remember. It is sad that in some instances caseworkers just view people under their care a cases and no longer as people.   Perhaps it is when one has worked at something for so long or has become jaded that they just classify these mechanically.   I suppo se one might say that objectivity is good, but in human services, too much objectivity can also be bad.   After all, in order to serve humans, one must recognize them as such. As I have seen from my grandmother, everyone of whatever age, race or gender, would like and should be entitled to keep their dignity and independence whatever way and form they can.My analysis of my self and my family show not just one family, but rather a group of individuals with different personalities, needs, ages, priorities and reactions to various situations.Just the simple terms a caseworker must use in communicating with different personalities and cultures are different. Thus, more thought must be given in communication between the caseworker and subject.   We being of Japanese descent have a culture that is very different from the West. To effectively deal with and talk to a Japanese, one must first see where the subject has come from and that necessitates sufficient understanding of Japanese c ulture, traditions, and way of life. It doesnt have to be in Nihonggo but simple respect and showing that one is not entirely ignorant on anothers culture would be very helpful.I believe that my experience has also taught me that keeping an open mind and respect for other cultures would greatly increase my efficiency as a human service worker in the respect of designing programs for individuals of various ethnicity and age-culture.   I have learned to adapt the view that even with similar infirmities, two people of two different backgrounds may need an approach that is different from the other in order for an adjustment or rehabilitation plan to work.Adjustments that must be done to accommodate new developments such as handicap, infirmity, illness, old age, and the like, must be done in ways that are still familiar and acceptable to the case subject. Perhaps perfect agreement may not always be possible but one must always be open to compromise and listen. Otherwise, there may be a strong resistance as there often is to drastic change.   People still need to feel like they are who they were before whatever the life-changing event is in their situation.   They need to still be able to recognize and enforce their own will as individuals and that is something caseworkers should always recognize and respect.The social caseworkers job is to help people adjust to their new circumstance. Not to make it harder.   It is only when there is complete understanding of an individuals background, beliefs, culture, and the kind of life they grew up with according to the times that one can effectively design a program for rehabilitation that is suited to that individuals needs.   One simply cannot impose their view of how people should feel or react in any given event.   The very arrogant I know what is best for you, is, from the start, not at all good for anyone who is forced to listen to it.   Much as these people maybe represented as folders with case numbers i n the office, a human services case worker must never let the humanity and recognition of individual differences be defined by theoretical studies and too stringent objectivity.

Consumer Driven Health Care Essay Example

Consumer Driven Health Care Essay Example Consumer Driven Health Care Paper Consumer Driven Health Care Paper Executive Summary The issues surrounding the full adoption of consumer driven health care range from cost pressures, employer concerns and the need of effectively engaging the consumers in decision making through the provision of adequate choice and information. Until now the government has been supremely instrumental in propelling the consumer driven health care system. While the merits remain engulfed in hot debates, the fact that consumer driven health care simultaneously creates both the movement, the financial responsibility, as well as the involvement in health care choices of the consumers has created serious concerns. As the evolution moves on, all stakeholders in the health care system are going to be affected. The plans will enable the consumers to personally navigate the system and directly engage with the providers. On the other hand, the pharmaceutical sector may become educators and an intermediary consumer movement may serve to satisfy the fact that transparent information will have bec ome a necessity for health care decisions. Leveled in line with these demands, the ensuing discussion analyzes the impacts on health care in terms of costs, efficiency and effectiveness in addition to the impacts with regard to the new consumer, and the stakeholders; notably the pharmaceutical sector. Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Descriptively, consumer driven health care system allows individuals to draw from their Health Savings Accounts or their Health Reimbursement Arrangements or such similar payment products to directly   meet routine health care expenses while protection from catastrophic health expenses is guaranteed by a high deductible health insurance policy. These policies cost less as the consumer meets routine medical claims from a pre-funded spending account. Should the balance in the account run out, medicals claims are paid just like in a regular deductible. Yearly unused balances increase future balances that can be invested for future medical expenses. The term â€Å"consumer driven health care† applies because routine medical claims are paid through a consumer controlled account verses a fixed insurance benefit. This scenario allows the consumers to occupy the role of a primary decision maker as regards the nature of health care they re ceive. Patients are therefore more likely to choose less expensive options and for those with chronic conditions, the system would promote compliance to treatment regimes(Goodman 2006).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Proponents of such a health care system argue that in the long run, Americans will pay less for health care provision because of reduced monthly premiums and increases free market variability. Market variability due to the use of Health Savings Accounts fosters competition which in turn lower prices and stimulate improvements in the quality and delivery of health care services. Opponents of the system cite the fact that individuals who are less wealthy and less educated will tend to avoid the health care cost burden, when this is coupled to the inability to make informed decisions, then the result is lowered health outcomes. Additionally, since the system simply shifts the cost burden to the patients, those with chronic conditions will never be able to save anything. In the end, inequality in health care quality and delivery may reign(Gross 2007).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Basically, consumer driven health care system is a derivative of the business model for health e-commerce ventures which were designed to enable consumers of health products and services to engage more directly with the providers in making the health care purchases. In essence, consumer driven health care is geared towards giving individuals more choice in making health care decisions and to help stabilize these costs. This system is a product of the same theories that sought to capitates payments to providers. The rejection of such a prompt gave rise to the consumer driven health care system(Kovner 2008). In the initial conceptual model, cost and quality of the relevant information was made available through the internet. The primary model relied on the creation of   Health Savings Accounts(HSAs) before the inclusion of a second model; the Health Reimbursement Arrangements(HRAs) which are funded by the employers who receive tax benefits for funding such accounts(Grudzien 2006).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Impacts of Consumer Driven Health Care   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The phrasal representation â€Å"consumer driven health care† is in itself a revelation of the transformation in health care where consumers of health care services and goods are gaining more and more importance in health care industry. The consumers being the purchasers of goods and services in the health care industry suggests an existence of economic relationships between the consumers and the suppliers. The word driven implies that the supplier is going to be compelled to react according to the consumers’ demands and position as regards the provision of these goods and services. Implicitly, the complete phrase can thus be used to describe a situation where there exists a two way business interaction that is able not only to transform the health system structure but also reconfigure the health industry to engage in a competitive conduct. Such a paradigm shift in the management of health care is bound to present strong chal lenges, advantages and disadvantages.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   What effect will such a system of health care have on the effectiveness and efficiency of health care provision? Currently in the United States, over $ 1 trillion dollars is spent annually on health care. Critically analyzed, this is 15% of the Gross Domestic Product and is more per capita that anything spent in other developed countries. The magnitude of the expenditure itself calls for a need a novel idea such as consumer driven health care. If such a system of health care were to be adopted, then what forces will shape the new consumer of health care services? On this basis, it is prudent to discern the effects of the key players such as employers, insurers, providers, and government entities. All these forces will only support such a system if most beneficial to them. A third scale of analysis desires that we look into the ways in which the industry is going to change. This analysis borders on the certainty of a fundamental restructuri ng of the system through a set of rules governing the new competitiveness. These structural changes will most certainly be orchestrated by the new nature of buyer-supplier relationship(Ferrari 2004). The Effect of Consumer Driven Health Care on the Efficiency and Effectiveness   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   To understand the changes that may occur in the efficiency and effectiveness after the transition to consumer driven health care, it is prudent to establish the objective function which measures productivity. Generally, productivity is descriptive of the magnitude of outputs achieved for a given level of inputs. In the health care industry, the physical inputs like labor, capital and supplies should be able to achieve certain levels of health outcomes. In essence, this means that productivity will be used in providing improvements on the management or treatment of diseases since this is the fundamental production process of the health care system. However, the simplicity of the productivity measure can only be taken to be useful and sustainable if it is coupled to the variety of other societal entanglements as well as other complexities in health care provision.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Given that the current health care system in the United States is the most expensive system in the world, a comparison with other developed countries on the basis of mortality and life expectancy attests that the system is less productive. However, on the basis of four disease states (diabetes, cholelithiasis, lung cancer and breast cancer), evidence suggested that it was more productive comparative to Germany and the United Kingdom. The high costs were attributable to the high administrative costs, higher compensation of doctors and other medical personnel. Consumer driven health care poses as the most reliable option in changing features which contribute to productivity hence health outcomes. For instance, a transformation to prospective payment from cost plus system of reimbursement for health institutions. Other reimbursement plans that supremely focus on the health outcomes rather that the activity also furthers the gains(Ferrari 2004 ). Customer driven health care has the ability to create incentives for providers to adopt more efficient technologies hence increasing productivity due to the underlying market competitiveness.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Since this transformation does not in any way threaten the existence of a competitive market, the cornerstone of such a market will have to be an informed buyer who has the capacity to make an accurate judgment of the value of outputs received with reference to the level of inputs injected into the system. This would usher in an era of comparative shopping among the suppliers as well as differentially reward the suppliers who provide the best goods and services at the least cost. Moreover, the system would also allow the buyer to choose a level of productivity that is desirable and affordable and trade off other savings for needs outside the health care system. Given the nature of the transformation and the rewards consequent to the paradigm shift, it is reasonable to expect an increase in productivity, improvement in health outcomes and the improvement on the efficiency and effectiveness of the health care system(Forster 2007). Forces Shaping the New Consumer   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There are two major forces that possess the potentiality of shaping the evolution and the pace of the novel system. The first force is the degree to which the buyers of health care goods and services become empowered to spend their own financial resources and making their own buying decisions. The second force is the quality of health care provision and the accessibility of the relevant information that pertains to the inputs and the outcomes in the health care process.   In the case of marginalized consumers with inadequate heath care information, there is going to a continuity of the turbulence as seen in the health care system today. Such a scenario slows down the transformation to consumer driven health care system. On the other hand, when marginalized consumers have the benefit of adequate information, the consumer as the main driving force in the system retains a marginalized role in the purchases but is also associated in the trade-offs(Herzlinger 2004). The end result is an unstable relationship among the players since consumers are well informed and possess the power to make their own decisions in seeking out productive suppliers.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Empowered consumers with inadequate information may create a scenario where there is a rush for the establishment of a brand making consumers to almost completely rely on the value associated with a brand. It is on the basis of such information that consumers will make their buying decisions. With the help of interpreters, superior information may be passed to consumers or alternatively, the interpreters may broker the brand to the consumers(Ferrari 2004). However, the best scenario is when there are empowered consumers in possession of adequate information. This scenario aptly captures the spirit of the productive economic system. It implies that the market is awash with consumers buying on their own account. The existence of such a scenario itself may eliminate the need for intermediaries. Not that there is going to be a vacuum where these intermediaries had occupied but that such a space will be occupied with a different faction, for instance, it may be the marketing or sales front end of the provider entities(Herzlinger 2007). This would demonstrate the productivity of the providers(suppliers of health services) to the consumers. Alternatively, the space may be occupied with an aggregator of consumers which may leverage the consumers’ volume power in negotiating a unit price for making the buying decisions.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In the end, the trend towards informed consumers who are able to make their own health care purchasing decisions will lead to an unprecedented change in the nature and quality of services and goods offered. These changes are not only positive in nature as they will shift the burden of health care costs on the shoulders of individuals. Such a change greatly challenges the deeply rooted societal perspectives on the roles of democratically elected governments. The creation of new consumer oriented intermediaries may usher in another era of misguided government regulatory intervention. Assuming that such a scenario does not arise then a consumer driven health care system has the potential to move health care provision to anew level of productivity hence better health outcomes for the United States citizenry.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   On the contrary, because of these sub classifications of consumers based on empowerment and availability of information, individuals who are less educated and healthy may avoid the needed health care services due to the cost burden coupled to the ability to make well informed and appropriate health decisions. Moreover, as Jonathan Oberlander; a political scientist at the University of North Carolina, Chapel Hill reiterates, the system simply shifts the health care cost burden back to the patients. Patients suffering from chronic health sicknesses may not be able to afford such costs, since with a deductible of between $ 3000 to $ 4000, these patients will thus be unable to save anything in their accounts. Employers are specifically impressed because the system is beneficial to them. They will not adequately fund replenish the employees health care accounts even though they will save money(Gross 2007).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The success of the consumer driven health care is dependent on the ready access to relevant information on health services, products and pricing. Due to the absence of free market variables in the health care industry, the lack of transparency will saddle consumers with additional expenses. This means that despite the theory that health insurance based on higher deductibles results in consumers shopping around for better products and services(based on quality and price), the inadequacy of such pertinent information practically goes against the attainment of benefits in a consumer driven health care model(Shearer 2007). Impacts on the Pharmaceutical Industry Currently the pharmaceutical industry has been shouldering the blame for the double digit increase in health care costs. Between the year 2001-2002, the consumer price index for health care increased by 4.4% while the industry index grew by 5.5%. A simple analysis of these percentages shows that the industry can only account for all the increase in the event that all other health care components shrunk. These statistics aside, the expenditure pent on informing consumers; $ 2.8 billion and a further $ 13.2 billion on informing doctors invariably increase the costs of health care in the long run. Therefore, unless new products are distributed for consumption without additional costs from these activities of pharmaceutical industries, the health care costs will continue to be high(Herzlinger 2004). Consumer driven health care has the potential of eliminating these costs hence advancing quality health care at lower costs.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Health care markets are extremely sensitive to the presence of a market power. Medical device companies and pharmaceutical companies retain monopoly over devices and drugs for a considerably long period of time due to the patent laws. It is during this period before the expiry of the monopoly period that these companies earn monopoly rents, in effect leading to higher drug pricing. This is unlike the traditional neoclassical supply curve(Jost 2007). This trend will be reversed as consumers will be looking out for cheap but equally effective therapeutic alternatives, hence bringing the prices down in the long run.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   With the death of the intermediary between the suppliers and the consumers, the pharmaceutical industry has started to align itself with the consumer of its products through direct to consumer advertising. This has only become necessary after the FDA lifted restrictions on direct to consumer advertising. This move has been viewed by many as a gap that allows the pharmaceutical companies to foist their drugs on the gullible public in the name of providing pertinent drug information. Moreover, the use of billions of dollars in advertising only increases the overall costs of the drugs.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   On the other hand, there are those who view direct to consumer advertising as being revolutionary and instrumental in promoting consumer involvement. Such an exposure of drugs to consumers acts as an educational tool and helps the consumers to be more informed in making decisions in health care. Apart from getting information direct from the pharmaceutical companies, information technology is increasing consumer empowerment making them seek high quality but less expensive choices(Mason et al 2007). Therefore, even though the pharmaceutical companies bypassed the physicians and moved directly to the consumer in advertising and promotion, consumer empowerment means that the era in which the extra expenditures were passed onto the consumers will be long gone. Such an eventuality will stimulate a dramatic restructuring of the industry. Conclusion   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The potential of a consumer driven health care system to improve the efficiency and effectiveness of the quality and delivery of health care are huge. However, the fact that access to health care is hinged on the ready access to relevant information remains the main obstacle in the realization of the full benefits. Health care and market forces are mutually exclusive. The existence of a competitive market; the cornerstone of which is an informed buyer increases the capacity of the buyer to make an accurate judgment of the value of outputs received with reference to the level of inputs injected into the system. So long as information is easily and cheaply accessible and transparency in the health care industry is promoted, the system may well be the answer to age old failures of the current most popular health care system. By putting insurance money under the complete control of the patients themselves, giving the employers cost relief, and eliminating the intermediary in the doctor-patient relationship, the system will undoubtedly achieve its health outcomes. References Ferrari, T. Bernard. (2004). 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