Assessing Poverty in South Asia

Assessing Poverty in South Asia Introduction UNDP has taken an initiative to publish SOUTH ASIA POVERTY MONITOR periodically to assess the poverty situation at national grassroots level through the existing national expertise in South Asia. As part of this initiative a country report will be prepared for Bangladesh as well. The Bangladesh country report will be prepared through both quantitative and qualitative approach. Unnayan Shamannay is proposing to conduct the qualitative part of the study. Rationale for Qualitative Approach Statistical data do help very little in understanding what the variation means. Qualitative data, on the other hand, illustrate the value of detailed, descriptive data in deepening our understanding of individual variation.They give rise synergistically to insights and solutions that would not come about without them (Palton 1990:15-17) Qualitative approach can provide a depth of understanding of the issues associated with poverty that the more formal and statistically valid approaches may not. This class of studies includes the increasingly popular techniques of rapid and participatory rural appraisal and beneficiary assessment (WB 1992: 8-4). Objectives The objectives of this study are as follows: Assess poverty through qualitative methodology Complement the quantitative approach with qualitative one. Add qualitative dimension to the Bangladesh Country Report. Scope The scope of this qualitative study will be to: Identify indicators of poverty through a participatory approach Identify and monitor changes in the poverty situation Assess the impact of some of the poverty alleviation measures Analyse the findings Topics/Issues to be Addressed Poverty profile and poverty indicators are some of the important components of poverty assessment. Poverty assessment will be carried out in participatory manner. Broad topics on the extent of poverty, identification of sub-groups, nature of poverty, characteristics of the poor and risk management have been included in the proposed research agenda. Moreover, poverty monitoring will also be conducted periodically and it will act as a barometer to measure the changes in various socio-economic and welfare indicators relating to the lives of the poorest households. Methods to be Used All major qualitative research methods will be used in the study. Interview will be extensively used in the study including its key variants, namely participatory group discussion, focus group discussion, standardised open-ended interview and case study (Figure 1). In addition to interview, other methods of qualitative inquiry, namely observation and document analysis will also be made use of in the study. Selection of Sample Areas Qualitative exercises will be conducted in both urban and rural settings of the country. To cover the greater diversity in socio-economic environments, three different regional configurations of northern, central and southern parts of the country would be accommodated in the study. A total of six villages including two from each part would be covered under the study. In urban area, at least three slum areas would be covered to facilitate the comparison and triangulation of data and information. However, for monitoring of poverty in the selected six villages and three urban slums, certain number of the poorest households will be selected from each of the study sites. Out of six villages, three will be selected in such a manner where at least anti-poverty intervention by government is in operation. These three villages will serve as programme villages and they will be drawn from the three parts of the country including one from each. Besides, other three villages will also be selected nearby where there is no poverty focused government intervention. These three will serve as control villages in the three parts of the country. Sample Size Most of the topics would be addressed at the community level and no specific number of participants are needed to be ascertained beforehand. For poverty monitoring, a total of 120 poorest households will be selected  ¾ 90 from six villages and 30 from three urban slums. The poorest households will be selected through consultation with the respective community members. Tools to be Used In selecting tools desirable characteristics namely easy, simple, visual, non-verbal etc., must be taken into accounts. As PRA tools are recognized to have all these desirable characteristics, most of the tools will be drawn from its repertoire. Important PRA tools that will be extensively used in the poverty assessment include scoring and ranking, matrix ranking, wealth/well-being ranking, time line, social mapping, pie chart and so forth (Figure 1). Validity and Reliability Although the qualitative data are essentially based on the perception, opinion and judgement of the participants, the quality of data would be, nevertheless, refined through of the triangulation principle underlying the research design of this study. A combination of multiple sources, researchers/facilitators and on-the-spot cross-checking of data through discussion, debate and deliberation among the community participants would minimise the degree of error and bias of data to the minimum. Besides, the field observation by the researchers would in addition , act as a guard against any major inconsistency and biasness of data. Activities to be Undertaken For conducting the study a number of activities will be undertaken. The activities include: Identifying and reviewing available literature Now-a-days wide ranging literature on poverty is available. Different facets of poverty have been discussed in those literature. The indicators, measurement process, sampling frame etc. also differ. For a qualitative study for monitoring poverty, the volume of the problem further increases. The approach is not only different but gives a deeper insight. To make it complement the qualitative approach the literature on poverty needs a review. For this purpose all available literature on poverty will be reviewed. Analyse presently used indicators Before finalising the indicators for assessment of poverty there is a need for analysing the presently used indicators. This will provide a rational basis for the use of the indicators in the qualitative study. Pre-testing The indicators and tools to be used in the study will be pre-tested in the field. This will help understand the effectiveness of tools. Primary field visit Before starting field work a primary field visit is needed to get acquainted with the actual field condition. Training of field/research officers The field/research officers who will be engaged in this study are competent and experienced. Even then the field/research officers need training/orientation for doing such work. With this purpose they will be imparted in-house and field training. Processing of data/information The data/information processing in qualitative study is not similar to that of quantitative one. The information generated through qualitative approach is processed in a different manner. Different factors and aspects of reality are considered while classifying these information. Field activities The field activities to be undertaken in this study will require two types of work: a. in rural area and b. in urban area. Rural area: The activities in rural area will require identifying the group/sub-group, building up rapport with them and conducting the sessions. These activities have to be co-ordinated with the day-to-day activities e.g., ploughing or rowing time etc., of the participants. Rrban area: In urban area conducting participatory session is a difficult task. Urban life makes it difficult for the participants to spare time for such research. Besides building up a better rapport, tools need to be designed and adjusted accordingly. Document analysis Significant insights can be found through document analysis. Even discrepancies between reality and pronounced goals can be identified. CHAPTER X PROBLEMS IDENTIFICATION AND NEEDS ASSESSMENT BY THE POOR Problems and Needs Assessment By the Poor Problems facing the poor were identified by the poor themselves, and a list of felt needs were the outcome of the participatory discussion, debates and consensus among themselves. Two sets of problems and needs were assessed in a participatory manner each for the urban and rural areas. Urban Setting To the urban slum poor, homelessness and eviction from slums are the topmost problems. Other serious problems identified by the poor include lack of good health and water facilities, employment opportunities, security, education, latrine, gas, etc. (Exhibit 38). Regarding the needs assessment, the urban poor listed and prioritized their felt needs. Some of the most important are, latrine, shelter, drinking water, electricity, gas, security, rationing, employment and so on (Exhibit 39). Rural Setting Agricultural inputs, irrigation and culverts are considered to be the topmost problems by the rural poor. Apart from these, some other most serious problems mentioned by them are related to health, electricity, unemployment, flood, drinking water, industrialisation, veterinary facilities, silting up of rivers etc. (Exhibit 40). According to the needs assessment and prioritization by the rural poor, some of the most important needs as articulated by themselves are industries for employment, agricultural inputs at a fair price, rural roads, irrigation, electricity, school and madrasa, medical facilities etc. (Exhibit 41). Chapter IX Monitoring THE Impact of Public Expenditure on Poverty Objective The primary objective of monitoring of impact of public expenditure on poverty in this chapter is to understand the living condition of the poor. This is more of an illustrative exercise rather than a whole sector monitoring of poverty. The issue of representativeness has to be, therefore, viewed in this context. One of the stated objectives of the development strategy of both present and previous governments is to reduce poverty. A growing share of public expenditure is claimed to have been allocated to the development activities ostensibly aiming at poverty reduction in the recent past, and this is likely to be continued in the future. Against this background of increasing the public expenditure allocation to poverty alleviating projects, it is needed to know the effects and impacts of these expenditure on poverty alleviation. In this section a number of key questions have been addressed: Does the benefit of the public expenditure reach those lying at the bottom of the income scale ? Is there any sign of improvement in the condition of the poorest of the poor ? How do the selected poverty indicators behave ? Do they improve, deteriorate or oscillate ? In case of improvement, at what pace do they improve ? Based on the findings from these questions, an attempt will be made to assess the quality of public expenditure in terms of a set of selected indicators. To understand the trend of the impact of public expenditure on poverty, we started monitoring the behaviour of some selected indicators of poverty in both the urban and rural areas since 1993 as the base year. The qualitative and quantitative data generated throu gh the participatory tools have been used for this poverty monitoring. This is the first round of the periodic monitoring of poverty in a participatory manner. Poverty Assessment and Monitoring: Peoples Views The poverty assessment carried out under this study has two components. The community members actively participated in the assessment of their well-being by listing and categorizing of all the households by themselves in several groups based on their own criteria. This is, in fact, a subjective assessment. Secondly, after categorization, all households were arranged in descending order on the basis of well-being scores of each of the households resulting in the identification of the poorest of the poor in the respective communities lying at the bottom of the scale with quantitative precision which was again vetted by the community members/participants. The poverty of some of the poorest households in the community has been monitored on the selected indicators. As this monitoring is based on hard data, it, therefore, gives us an objective assessment of the living standard of the poorest. (Figure 9.1) The poverty sitution in the urban and rural areas has been assessed in a participator y manner. Instead of applying any pre-conceived ideas, standards, measures or categories by the researchers to measure poverty as is done conventionally, the criteria used in this study has been developed by the people at the community level. The basic question relating to poverty measurement or assessment is who is poor and how to identify him/her. Based mainly on qualitative data information Based mainly on quantitative data information Criteria Unlike a single standard or formula as applied in the conventional methodology, the community-members consider it appropriate to use a set of socio-economic criteria to assess the economic and social status of a household. For this purpose, the researchers and facilitators involved in the study initiated a series of group-level discussions and community-level validations. The community people developed their own criteria (Box 9.1) to assess the status of their own members and also to categorize them into a set of social classes. The more important criteria developed by the rural people in the selected villages are, among others, the amount of land owned and cultivated, the number of earning members, cash in hand, the housing condition, the amount of fixed assets, the family size, other sources of income, whether a household is female or male headed, etc. Prevalence of poverty Based on the above criteria, the community people identified the poor (moderate poor) and the poorest (extreme or hardcore poor) households in their own community. As poverty was assessed at the household level, the status of all the households in the community was assessed and categorized into four classes, namely well-off, medium, poor and poorest. In the urban slums, 72 percent of the households were found poor (moderate: 51, hardcore: 21) and 28 percent non-poor (middle: 19, well-off:9) (Tables 9.1 and 9.2). The incidence of poverty was, however, found to be widely different in different slums. In one sample slum there were no well-off households in 1996 although there were many in another sample. In the rural area, 75 percent of the households were classified as poor (moderate: 20 and hardcore: 55) whereas 25 percent were classified as non-poor (middle:14 and well-off: 11) (Table 9.3). Regionally, the incidence of poverty was more acute (moderate: 17, hardcore: 60) in the central part compared to that (moderate: 25, hardcore:47) in the northern part. The findings generated by the PRA exercise were further validated by the people in the respective community. So the scope of subjective bias, if any, was greatly reduced. Poverty Monitoring Using Panel Data Set (Quantitative) Being a value loaded term, poverty as such cannot be measured quantitatively/objectively. The debate on the issue abounds in the literature. But the symptoms and aspects of poverty can be measured and monitored by means of a series of socio-economic indicators that proxy the level of well-being of people. That is why, an attempt has been made in this section to measure and monitor poverty through a number of indicators/variables in two different years i.e., 1993 and 1996. Most of the indicators used for monitoring were suggested by the community members (Box 9.1.). The number of indicators used here are meant to have satisfied the desirable criteria, namely, unambiguity, consistency, specificity, sensitivity and ease of collection (Carvalho and White, 1994). Change in Demographic and Socio-economic Profiles of the Poorest Households During 1993-96 Demographic and Social Characterstics Family size and composition The population of the poorest households and their average family size grew by 5 percent over the monitoring period 1993-96 (Table 9.4). However, the populatioin growth rate is found to have been higher at 7.2 percent for the urban poor compared to 4.4 percent in the rural area over the same period. The family size of the poorest households in the rural area is, however, found to be higher at 4.2 in 1993 and increased further to 4.4 in 1996. The family size of the urban poor was lower at 3.5 in 1993, and it grew to 3.7 in 1996. In the rural area, the family size of the FFE-households is found to be much higher at 6.0 on an average in both the central and northern parts compared to those for the non-FFE households in both programme and control villages in 1996 (Table 9.5). Another important demographic characteristic of the poorest households is their family composition. In 1996, the FFE households are found to have a male majority  ¾ 61 percent compared to 49 percent and 41 percent for the non-FFE households in the programme and control villages respectively. The family composition is, however, found reverse for the poorest families in the urban slums. The poorest households had a female majority at 62 percent in 1996 (Table 9.6). The above findings pose some questions challenging the appropriateness of the main thrust of the development strategy being pursued by the government in the country. The much-publicized motto two children are enough seems to have been irrelevant so far as the poorest people are concerned in both the urban and rural areas. The increasing growth rates in populatioin and family size suggest that under the existing socio-economic conditions, their economic and social securities lie not in smaller family but in larger one. Earning members and incidence of child labour The poorest households and their different groups are found to have peculiar characterstics in the composition of their earning members. Overall, close to half of the earning members are men, and one-fourth are women and boys each in 1996 (Table 7.17). Against this general distribution of the earning members, the poorest families in the urban and rural areas are found to have different compositions of earning members by age and gender. In the urban slums, female earning members accounted for 43 percent (women: 36% and girls: 7%) among all the earners compared to 24 percent (women:23% girls:1%) in the rural area (Table 7.17 and 9.7). Female children are not found to have been as active in income earning activities previously as they are found to be in 1996. The preponderance of male income earners is found to be more prominent among the poorest households in the rural area. At the disaggregate level, the difference is more revealing in the rural areas. The participation of girls in income earning activities is found to be very minimal throughout the rural areas (Table 9.8). Among the FFE-households, womens participation in income earning activities is very small (3%), but it is widely observed (33%-36%) among the non-FFE households . Among the FFE households, the preponderance of male child labour is observed, and this remained unchanged throughout the monitoring period despite the programme intervention in the rural areas. The incidence of child labour among the earning members of the FFE households is found to be 40 and 41 percent in the central and northern parts respectively of the country, and this remained unchanged in both the areas during the period 1993-1996. The poor impact of the FFE programme on the incidence of child labour at large in the rural areas is also revealed sharply if we focus on the trend in the incidence of child labour. Overall, 25 percent of the boys of all ages were involved in income earning activities in 1993, and this remained almost at the same level (24%) in 1996. As the boys, the incidence of female child labour among the earning members is found to be at a much lower level (1.2%) in 1993 and this remained at that level 1996 as well. The above findings raise an important question to the fore: why is the FFE programme found to be ineffective in reducing the incidence of child labour ? The answer to this question should be searched not in the programme itself but in the economics. For the poorest households, the opportunity cost of sparing a boy from education is around Tk. 14 a day (wage rate) in 1996 (Table 9.9). The financial benefit gained from the FFE programme by a rural poor household is found not so significant at Tk. 4.85 (Tk. 0.81 per capita per day) a day for a boy (Table 9.10). The participatioin of a poor family in the FFE programme causes a substantial income loss to that family. As the benefit under the programme cannot offset the income loss that an extremely poor family has to incur, the appeal of the programme to a precariously income-poor family is found to be weak. This finding is found consistent with that of other studies (Ahmed and Billah,1995). Female-headed households One of the important demographic features of the poorest households is that close to one-third of them were female-headed during the reference period (Table 9.11). More than half of the sample households (55%) are found to be female-headed in the urban slums compared to 23% in the rural households during the same period. Another important demographic feature of the three groups of the poorest households is that only 5 percent of the FFE households have been female headed compared to 25 percent and 40 percent for the non-FFE households respectively in the programme and control villages in 1993 (Table 9.12A). This composition remained unchanged even in 1996. The above findings suggest that the FFE households are found to be relatively stable not only in respect of assets (details later) but also demographically. The preponderance of female-headed households among the non-FFE household groups imply that these households are not only income-poor but also subject to a higher degree of vulnerability and defencelessness both economically and socially. In the urban slums, a significant portion of the poorest households happened to be female-headed during the monitoring period (Table 9.12B) The gender focus of poverty is found more pronounced among the poorest segment of the slum-dwellers compared to those in the rural area. Table 9.11 shows that more than half (55%) of the sample households have been female-headed compared to that (23%) among the rural counterparts during the same period. Begging households Altogether, 6% of the poorest households are found engaged in begging. In the urban slums, none of the poorest households is found in this category (Table 9.13) and all begging households under our sample belong to the rural area. Besides, all these households are found among the non-FFE groups. (Table 9.14). These households are more vulnerable and extremely poverty-ridden mainly due to some unfavourable demographic factors. The households engaged in begging are relatively small (3.8) in family size compared to the sample average (4.2) in 1996. Moreover, the dependancy ratio for the begging households is lower (2.7) compared to that for the sample households (3.0) in 1996.The predominance of women among the earning members points to the poor income level of these households. As the dependency ratio is very low, it implies that most of the family members are forced to go for earning activities due to their poverty. Income Source of income The poorest households have limited sources of income. The urban poor are usually engaged in unskilled manual labour. Similar is the case with the rural poor (Table: 9.15) as well. Sale of labour has been the main source of the rural poor accounting for 82% of their total income in 1993. This has marginally increased to 84 in 1996. Agriculture is the second most important source of income making up only 12% of the total income of the rural poor in 1993 and 10% in 1996. Only 1% of the income of the rural poor has been derived from livestock, a new source of income, in 1996. Nominal income In the rural area, the income of the poorest households has been found to be miserably low during the monitoring period. The per capita daily income of these households was Tk. 6.9 in 1993. This increased to Tk. 7.4 in 1996 showing an 7% growth (Table 9.16). Their per household daily income grew by 12% from Tk. 29 in 1993 to Tk 33 in 1996. The higher growth rate of nominal income is mainly due to a positive growth of the nominal wage rate (12%) alongwith a growth of the number of earning members (5%) of the poorest households. The low per capita income is partly due to the large family size and its growth over the monitoring period. The low income of the poorest households is the result of a number of socio-economic factors, e.g., low wage rate (Table 9.9), poor asset base, poor human capability due to illiteracy (Tables 7.31 and 7.32), low access to economic opportunities, etc. The impact of the FFE programme does not seem to have been appreciable on the level of income of the programme households. Although the programme has had some positive impact on the growth of income (15% in per capita and 18% in per households terms during 1993-1996), its contribution to the growth is difficult to ascertain. However, other findings indicate that the contribution of the programme to the income of the programme households is insignificant (Tk. 0.81 per capita/daily, Tk. 4.85 per household/daily, 15% of the average household income) (Tables 9.10 and 9.16). The per capita nominal income of the poorest households in the urban slums was Tk. 12 a day in 1993 and increased to Tk. 19 a day in 1996 representing a 31 percent growth (Table 9.17). The per household daily income of the urban poor increased by a higher rate of 40 percent from Tk. 41 a day to Tk. 58 during the same period. The income of the urban poor increased by a much higher rate than that of the rural poor in both per capita and per household terms because of the higher growth rates of wage (29%) (Table 9.9) and of earners per household (17%) (Table 9.7), lower family size (3.7), etc. Moreover, gainful economic opportunities are greater in the urban area relative to the rural area. Real income The income of the poorest households in real terms (in kilogram of coarse rice) is found to have declined across the board during the monitoring period. In the rural area, the per capita real income of the poorest households declined by 22% on an average from 0.9 in 1993 to 0.7 kilograms of coarse rice in 1996 (Table 9.18). Barring the FFE households, the per household real income has registered a sharp decline during the same period irrespective of differences in regional diversity. Due to the income support under the FFE programme, the FFE households could avoid the sharp fall of income. The per capita real income for the FFE households has declined by 13% against a 20 to 25 percent decline for the non-FFE households over the same peiod. Overall, despite an 7% increase in per capita income in nominal terms on an average during 1993-96 (Table 9.16), the corresponding real income took an appreciably higher downward trend (22%) (Table 9.18) caused by a 24 to 43 percent price hike of c oarse rice in the rural areas during the same peirod (Table 9.19). The per capita real income of the urban poor remained unchanged, whereas, the per household real income marked an upward trend (5%) during the monitoring period (Table 9.20). The per capita real income of the urban poor is almost double at 1.4 kg a day of that of the rural poor in 1993 which remained almost unchanged during the same period. The per household real income of the poorest households stood in urban slums at 4.7 kg and 5.0 kg a day in 1993 and 1996 respectively recording a 5% growth. The poorest households in the urban slums are relatively better off than their rural counterparts in respect of per household real income which declined by 16% for the latter during the same period (Table 9.18). Wage rate The unskilled wage rate is considered to be an important indicator for monitoring poverty. The wage rate of all categories of unskilled wage labourers is found to have increased in both the rural and urban areas (Table 9.9). In the rural area, the daily nominal wage rate increased by 11.7% from Tk. 17.2 in 1993 to Tk. 19.2 in 1996 (Tables 9.7, 9.16, 9.24 and 9.25). The wage rate is found to be much higher for the urban slum-dwellers, and it grew by 29% from the level of Tk. 35.8 in 1993 to Tk. 46.1 in 1996 (Tables 9.9, 9.21, 9.22 and 9.23). Although the wage rate for unskilled labourers increased during the monitoring period, the purchasing power of the poor labourers did not rise due to a higher rate of price increase in the case of coarse rice. The average wage rate for unskilled wage labourers, in fact, declined across the board in real terms during the monitoring period. However, the poor in the northern part had to sustain a much higher rate of fall (22%) in real wage rate compared to 14% for those in the central part during this period (Table 9.24). Consumption Consumption of food The consumption of rice and wheat  ¾ the staple food items of the poorest households  ¾ is found to have recorded opposite trends among these households in the urban and rural areas. In the urban slums, the per capita daily consumption of food (rice and wheat) was 442 grams in 1993 and it rose to 514 grams in 1996 representing a 16 per cent growth (Table 9.25). The increase in the consumption level of food in terms of both per adult equivalent unit and per household units has also been substantial, 18 and 25 percent respectively during the monitoring period. These findings, however, conceal the substantially low level of food intake observed in one of the slums where poverty is found to be more acute (Table 9.26). In the rural area, the trend in food consumption is, however, found to have consistantly sunk during the monitoring period in per capita and per adult equivalent and per household terms (Table 9.27). The per capita daily consumption of rice and wheat declined from the level of 585 grams in 1993 to 566 in 1996 showing a 3 percent decrease. The food consumption per adult equivalent unit is found to have been at a much higher level  ¾ 797 grams in 1993 and 786 grams a day in 1996 – recording a relatively small fall during the period. Per household consumption, likewise declined during the same period. The declining trend in food intake is true of both the programme and non-programme households during the same period. The consistent fall in the level of consumption of food is largely due to the fall in real income and expansion of the average family size of the poorest households during the monitoring period. Box 9.2: Food Security: A Quantitative Assessment In order to assess the poverty status of sample households, the heads of the households were asked to make self-assessments in respect of poverty. Their self-assessed status may be categorized as follows: Chronic deficit households reporting food shortage throughout the year; Occasional deficit households reporting food shortage occasionally in a year;

Medical Tourism On Public Health Health And Social Care Essay

IntroductionSurveies on wellness related mobility have long paid attending to the migration of patients from less developed states to industrialised states in hunt of wellness services that are unavailable in their state of beginning ( Paffhausen, et al. , 2010 ) . Recently, motion in the opposite way, which is referred to as medical touristry, has captured the involvement of the media ( Horowitz, et al. , 2007 ) . Medical touristry describes the phenomenon of citizens from extremely developed states going to states at variable degrees of development for world-class but low-cost medical services that are non available in their ain communities ( Bookman & A ; Bookman, 2007 ; Woodman, 2007 ) . Unlike wellness touristry which is by and large viewed as a pleasure-oriented touristry affecting gratifying and restful activities ( Pollock & A ; Williams, 2000 ; Bennett, et al. , 2004 ) , medical touristry is distinguished from wellness touristry by the earnestness of unwellness and the degree of physical intercession required ( Hendersen, 2004 ; Carrera & A ; Bridges, 2006 ; Connell, 2006 ) . In this regard, Hendersen ( 2004, p.113 ) defines medical touristry as a pattern that ‘incorporates wellness showing, hospitalization, and surgical operations ‘ . This essay will concentrate the treatment on a figure of medical touristry issues with mention to economic theory including market drivers and determiners of demand for medical touristry, the crowding-out and crowding-in effects of medical touristry on public wellness of hosting states. The essay begins with the market drivers and determiners of demand for medical touristry. This will be followed by treatment of the ability of medical touristry in bettering public wellness – the crowding-in consequence. The essay will so discourse the crowding-out consequence of medical touristry – the fact that national resources are diverted from public heath to more profitable private services for international patients.Market drivers and determiners of demand for medical touristryAlthough medical touristry is an emerging industry ( Hopkins, et al. , 2010 ; Paffhausen, 2010 ) , the industry itself has grown dramatically over the past decennary ( Bookman & A ; Bookman, 2007 ; Paffhausen, 2010 ) . The rapid growing of the planetary medical touristry industry is facilitated by the important addition in demand for cross-border medical interventions which is fuelled by a figure of factors such as high wellness attention costs, expensive insurance premiums, long waiting l ists, and high income in developed states ( Horowitz & A ; Rosensweig, 2007 ; Bookman & A ; Bookman, 2007 ) . Health attention costs are a push and a pull of demand for medical touristry 1There is incompatibility in the value of monetary value snap of demand for wellness attention among different surveies and different medical services. For physician services, Lee and Hadley ( 1981 ) found that monetary value snap of demand is about -2.8 to -5.07, while in the survey of McCarthy ( 1985 ) the value was -3.07 to -3.26. At hospital degree, monetary value snap of demand for wellness attention is smaller, runing from -0.8 for patient yearss to -1.1 for admittances ( Feldman & A ; Dowd, 1986 ) . Rosett and Huang ( 1973 ) found that outgo for wellness attention is sensitive to monetary value, with monetary value snap of -0.35 to -1.5. Although different surveies yield different Numberss and different groups of people may hold different degree of sensitiveness to monetary value, these surveies tell us the same narrative: demand for wellness attention is monetary value elastic. Health attention market faces high monetary value snap of demand and patients are sensitive to price1 ( Rosett & A ; Huang, 1973 ; Lee & A ; Hadley, 1981 ; McCarthy, 1985 ; Feldman & A ; Dowd, 1986 ) . In fact, the primary ground why people travel in hunt of wellness attention is monetary value considerations ( Bookman & A ; Bookman, 2007 ) . Harmonizing to microeconomic theory, as wellness attention costs rise, the demand for wellness attention would diminish as a consequence ( McPake & A ; Normand, 2008 ; Folland, et al. , 2010 ) . As a rational economic person, in the attempt to minimise costs of wellness attention and maximise public-service corporation, the patient has become a medical tourer ( Bookman & A ; Bookman, 2007 ) . Like other trade goods, monetary value is one of the most of import determiners of measure demanded for wellness attention ( McPake & A ; Normand, 2008 ; Folland, et al. , 2010 ) . Rising wellness attention costs in place scenes and significantly lower monetary values of medical interventions in finish states are playing as a push and a pull severally of demand for medical touristry ( Bookman & A ; Bookman, 2007 ) . In the United States ( US ) , for illustration, it is estimated that the national wellness outgo has raised by 43.5 % from $ 1.3 trillion in 2003 to $ 2.8 trillion in 2008, of which 12 % ( $ 278 million ) was from personal payments ( US Center for Medicare and Medicaid Services, 2008 ) . This go oning addition in heath outgo exacts a great toll on wellness attention consumers. A survey by Himmelstein ( 2009 ) reveals that in 2007, over 62.1 % of all bankruptcies in the US were medical, and wellness attention costs have become the fastest turning constituent of Americans ‘ market basket. As a consequence, patients are pushed to go to where their demand can be met with low-cost monetary values to increase public-service corporation. With the lifting wellness attention costs in industrialised states, high quality services at important lower monetary values in developing states have become the inducement for patients seeking interventions abroad. Harmonizing to Deloitte ( 2008 ) , medical services in India, Thailand, Singapore can be every bit low as 10 % of those in the US, while other surveies reveals that the costs in some medical touristry finishs can be 30 % -70 % cheaper than those that medical tourers have to pay in their states ( Mugomba & A ; Danell, 2007 cited in Paffhausen, 2010 ) . The cost that includes airfare and holiday bundle of a bosom valve replacing surgery, for illustration, is merely $ 10,000 in India, while it costs $ 200,000 in the US ( Bookman & A ; Bookman, 2007 ) . Hospitals in Singapore charge $ 18,000 for a knee replacing with a six twenty-four hours in-patient intervention which would be a patient $ 30,000 in the US ( Herrick, 2007 ) . World-class medical interventions with significan tly cheaper monetary values in developing states have been drawing the possible wellness attention consumers in developed states to prosecute interventions overseas ( Bookman & A ; Bookman, 2007 ) . Insurance coverage, waiting clip, and income Econometric patterning on heath attention ingestion behavior suggests that insurance coverage, deductibles, and co-payments are among the variables of the demand map for wellness attention with negative correlativity coefficients ( Folland, et al. , 2010 ) . High wellness insurance premiums means people tend to purchase low-budget programs that merely cover a little basket of heath services or people may take non to purchase insurance ( Bookman & A ; Bookman, 2007 ) . It is estimated that over 46 million Americans are uninsured, doing nest eggs on medical processs abroad more attractive ( Starr & A ; Fernandopulle, 2005 ; Milstein & A ; Smith, 2006 ) . In add-on, high deductibles and co-payment sometimes make the cost of wellness attention out of range of patients even though they have insurance ( Bookman & A ; Bookman, 2007 ) . Given demand for wellness attention is infinite and patient ‘s income is finite, it is non surprising to see people going to seek medical interventions outside their states ( Bookman & A ; Bookman, 2007 ) . In states where there is a national health care plan such as Canada and the United Kingdom, waiting clip is the figure one barrier to entree to wellness attention ( Statistics Canada, 2005 ; Horowitz, et al. , 2007 ; Turner, 2007 ) . A recent survey finds that Canadians wait an norm of 8.4 hebdomads for General Practitioner ‘s referral to a specializer and delay another 9.5 hebdomads for intervention ( Asia Pacific Post, 2005 cited in Conrady & A ; Buck, 2008 ) . When a waiting list for a peculiar process is excessively long, the patients, particularly those who have high clip monetary values, may be willing to short-circuit the free services offered at place and travel abroad to hold a timely intervention and accomplish satisfaction Oklahoman ( Hopkins, 2010 ) . An extra factor that fuels medical touristry demand is income. Harmonizing to microeconomic theory, the more disposable income a individual has, the more it is available for ingestion, including the ingestion of wellness services ( Bookman & A ; Bookman, 2007 ; Pindyck & A ; Rubinfeld, 2009 ) . Therefore, high income translates into the possibility of purchasing more wellness and preventative medical specialty ( Bookman & A ; Bookman, 2007 ) .Medical touristry and public wellness: crowding-in consequenceMedial touristry has become one of the most of import national economic activities thanks to the advantages it provides to hosting states ( UNESCAP, 2009 ) . The advantages such as economic addition, improved medical substructure and external encephalon drain decrease enable medical touristry to better and spread out public wellness, which is known as the crowding-in consequence of medical touristry ( Bookman & A ; Bookman, 2007 ) . Available information reveals that the planetary medical touristry industry generated about $ 60 billion in grosss in 2008 and the figure is projected to be $ 188 billion by the terminal of 2010 ( Deloitte, 2008 ) . Through cross-subsidization, the ensuing grosss can be reinvested in public wellness which consequences in increased entree, greater coverage, and improved quality of wellness attention for the local population ( Bookman & A ; Bookman, 2007 ; Hopkins, 2010 ) . Cross-subsidization can besides take the signifier of sharing infirmary beds, heath professionals, and medical substructure ( Bookman & A ; Bookman, 2007 ) . Thailand, Argentina, and Malaysia, for illustration, have been utilizing telemedicine – a portion of technological invention associated with medical touristry – to supply wellness attention to advance parts ( Bookman & A ; Bookman, 2007 ) . Hence, the development of medical touristry, through macroeconomic redistribution policy, can heighten publi c heath and bring forth positive outwardness.Medical touristry and public wellness: crowding-out consequenceBing considered as a major stimulation of socioeconomic development through advancing medical touristry, private infirmaries have been having considerable subsidies from authorities ( Bookman & A ; Bookman, 2007 ; UNESCAP, 2009 ) . Given scarce resource, such support may take away resources from public wellness attention. Promoting medical touristry besides diverts human resource off from public services to private sector where heath attention staff may have higher income and work in an international criterion environment ( Sen, 2008 ) . In Thailand, for illustration, 6,000 places in public wellness services are still remained unfilled as an addition figure of wellness attention forces is attracted by higher wage and better working environment in private sector ( Saniotis, 2008 ) . Private infirmaries in Malaysia employ 54 % of the state ‘s physicians while accounting fo r merely 20 % of entire infirmary beds ( Gross, 1999 ) . In India, 80 % of wellness outgo is now in the private sector, while about half of all Indian adult females still present their babes without medical attenders ( WHO Statistical Information System, 2006 ) . By concentrating national resources for international patients, the hosting state may put on the line denying its ain citizen just entree to care, and make a double market construction for wellness attention in which one section of high quality services is for aliens and the other of lower quality is for local patients ( Bookman & A ; Bookman, 2007 ) . The ground underlying this polarisation is the tradeoff between the resources for public wellness and those for medical touristry ( Bookman & A ; Bookman, 2007 ) . Health attention for local population is crowded out as most of the resources are enticed off from local patients ( Bookman & A ; Bookman, 2007 ) . This double market construction besides creates a state of affairs in which those who need less care normally acquire overtreatment while excepting the neediest 1s or cut downing their use ( Bookman & A ; Bookman, 2007 ) .DecisionMedical touristry refers to patients going from developed states to less developed or developing stat es for medical interventions. Medical touristry is market driven in which sky-rocketing wellness attention costs, expensive wellness insurance premiums, long waiting list at place are obliging grounds for patients from western states to seek cross-border interventions. Theoretical and empirical groundss prove that medical touristry crowds in public wellness thanks to the advantages it brings to destination states such as revenue enhancement grosss, decrease in encephalon drain and improved medical substructure. However, medical touristry besides crowds out public heath of finish states by taking resources off from public wellness services. For-profit private infirmaries could sabotage quality of attention at public wellness installations for local population. With higher wage and better working status at private installations, public wellness establishments may endure internal encephalon drain. Therefore, medical touristry has both positive and negative impacts on hosting states ‘ public wellness, and these effects should have equal attending they deserve.

Fcl-Prince of Persia - Free Essay Example

Sample details Pages: 4 Words: 1312 Downloads: 5 Date added: 2017/09/11 Category Advertising Essay Did you like this example? Movie: Prince of Persia 1. Describe the leadership style In the story The Prince of Persia Dastan with his two brothers: Garsiv and Tus plan battle strategies, a spy sends word that the Holy City of Alamut has been supplying weapons to enemies of Persia. Taking matters into his own hands, Tus orders an attack on the sacred city and upon its fall Dastan encounters the beautiful Princess Tamina. When King Sharaman dies under mysterious circumstances shortly after, and Dastan is accused of his murder, he flees with the princess on a harrowing mission to clear his name. Learning from Tamina the true motives behind Alamuts invasion, Dastan must embark on a perilous quest to stop an evil masterminds plot for ultimate power with a mystical weapon that can control the very fabric of time. He manages to handle it well so that it’ll not be handed by the dark forces. In Persia, in the Royal City of Nasaf, the fair King Sharaman rules the empire with his brother Nizan. Sharaman has two sons, but adopts the orphan Dastan that becomes part of his family. Don’t waste time! Our writers will create an original "Fcl-Prince of Persia" essay for you Create order Years later, the Holy City of Alamut ruled by Princess Tamina is under siege of the troops led by Tus, Garsiv and Dastan, after their uncle Nizan had intercepted a spy carrying weapons for Alamut. Dastan invades the city with his men to avoid a massacre and the Persian army conquers the city. Dastan gets a dagger from an enemy and King Sharaman comes to Almut very upset with the invasion of the holy city. Then he arranges the marriage of Dastan with Princess Tamina. When Dastan gives a holy cloak delivered by Tus to his father, the mantle is poisoned and kills Sharaman. Dastan is accused of betrayal but he escapes with Princess Tamina. Sooner he finds that the dagger is a powerful device to travel and change time and that Tus is not the traitor and he engages with Tamina in a quest for justice. The leadership type that is taken in the story Prince of Persia is Strategic Leadership. This leadership allows the leader to think first before doing an action, provides the vision and direction for the growth and success of an organization. To successfully deal with change, all executives need the skills and tools for both strategy formulation and implementation. Managing change and ambiguity requires strategic leaders who not only provide a sense of direction, but who can also build ownership and alignment within their workgroups to implement change. 2. ) Compare to other types of leadership ? The Laissez Faire Leadership Style The style is largely a hands off view that tends to minimize the amount of direction and face time required. Works well if you have highly trained and highly motivated direct reports. ? The Autocratic Leadership Style The autocratic style has its advocates, but it is falling out of favor in many countries. Some people have argued that the style is popular with todays CEOs, who have much in common with feudal lords in Medieval Europe. ? The Participative Leadership Style Its hard to order and demand someone to be creative, perform as a team, solve complex problems, improve quality, and provide outstanding customer service. The style presents a happy medium between over controlling (micromanaging) and not being engaged and tends to be seen in organizations that must innovate to prosper. Situational Leadership Situational Leadership. In the 1950s, management theorists from Ohio State University and the University of Michigan published a series of studies to determine whether leaders should be more task or relationship (people) oriented. The importance of the research cannot be over estimated since leaders tend to have a dominant style; a leadership style they use in a wide variety of situations. Surprisingly, the research discovered that there is no one best style: leaders must adjust their leadership style to the situation as well as to the people being led. The Emergent Leadership Style Contrary to the belief of many, groups do not automatically accept a new boss as leader. We see a number of ineffective managers who didnt know the behaviors to use when one taking over a new group. ? The Transactional Leadership Style The approach emphasizes getting things done within the umbrella of the status quo; almost in opposition to the goals of the transformational leadership. Its considered to be a by the book approach in which the person works within the rules. As such, its commonly seen in large, bureaucratic organizations. The Transformational Leadership Style The primary focus of this leadership style is to make change happen in: †¢ Our Self, †¢ Others, †¢ Groups, and †¢ Organizations Charisma is a special leadership style commonly associated with transformational leadership. While extremely powerful, it is extremely hard to teach. Visionary Leadership, The leadership style focuses on how the leader defines the future for followers and moves them toward it. ? Team Leadership A few years ago, a large corporation decided that supervisors were no longer needed and those in charges were suddenly made team leaders. Today, companies have gotten smarter about teams, but it still takes leadership to transition a group into a team. ? Facilitative Leadership This is a special style that anyone who runs a meeting can employ. Rather than being directive, one uses a number of indirect communication patterns to help the group reach consensus. ? Leadership Influence Styles Here one looks at the behaviors associated how one exercises influence. For example, does the person mostly punish? Do they know how to reward? ? Cross-Cultural Leadership Not all individuals can adapt to the leadership styles expected in a ifferent culture; whether that culture is organizational or national. ? Coaching A great coach is definitely a leader who also possesses a unique giftthe ability to teach and train. ? Level 5 Leadership This term was coined by Jim Collins in his book Good to Great: Why Some Company’s make the Leap and Other Don’t. As Collins says in his book, We were surprised, shocked really, to discover the types of leadership required for turning a good company into a great one. What he seems to have found is what The Economist calls The Cult of the Faceless Boss. ? Servant Leadership Some leaders have put the needs of their followers first. For example, the motto of the Los Angeles Police Department, To Protect and Serve. reflects this philosophy of service. One suspects these leaders are rare in busine ss. 3. ) Do you agree w/ the leadership style of the protagonist? Yes, because he manages the situation well and he thinks before he leaps. Even though he struggle a lot of problem he manages to think about how to marshal the resources/people to execute strategy. The protagonist holds up the main solution until the end without abusing it, but rather thinks of it as the primary solution for the problem. He also manages to handle a team that in the future fortunately will help them against the enemies, like he invest for the future. I agree to his leadership not just because he saves his country but rather he uses this strategy to save his love ones. 4. ) If you’re in the place of the protagonist, are you going to apply the same leadership style? Yes, because as I watch that movie he was in the palm of a good hand or should I say he’s the good guy. I want to lead the way that he does because the result was to save his country. He manages it so well that in the end he got what he deserves. His leadership style, the strategic leadership allows us to think of what should we do before we put that in an action. He approximately believes that he can handle the situation well that even his life was at risk. I want to lead a way to change my country like the protagonist did. His story was a good inspiration

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