Analysis of Heavy Metals Contamination in Urban Dust

Analysis of Heavy Metals Contamination in Urban Dust 2.1 REVIEW OF REPORTED STUDIES 2.1.1 Assessment of Heavy Metal in Street Dust in Kathmandu Metropolitan City and their Possible Impacts on the Environment. Chirika S.T. Pawan R.S.9 conducted a study in 2011 to determine the levels of heavy metals in street dust at different localities in the Metropolitan City of Kathmandu, Nepal. A total of 20 street dust samples were collected from four sampling sites such as mechanical workshops, motor parks, market areas and residential areas as well as dust were collected from sites which were not affected by traffic. The collected samples were digested using aqua regia through microwave digestion and heavy metals were determined using a SOLAAR M5 Dual Automizer Atomic Absorption Spectrophotometer. The mean concentration of level of lead and nickel were 80.3 and 52.9 Â µg/g. However, the highest lead concentration was 116.8 Â µg/g at the mechanical workshop, which were directly associated with the emissions from vehicles exhaust since vehicles were still using leaded gasoline although it was banned in Nepal. 2.1.2 Multivariate analysis of heavy metals contamination in urban dust of Xi’an, Central China For this study undertaken in 2005, Yongming H. et al.23 collected sixty-five samples of urban dust in Xi’an. The aim of this study was to determine the level of heavy metals such as Pb, Cr, Ag, Hg, Mn, Sb, Zn, Cu and As, as well as to identity their natural sources. Xi’an was selected for this study since it was the central city consisting of heavy metals industries, textile industries and chemical industries. The collected samples were digested using HF, HNO3, H2SO4 and HClO4. The determination of heavy metals such as Cu, Pb, Zn, Cr, Ag and Mn where carried out using Vario 6 atomic absorption spectrophotometer whereas Hg, As and Sb were analyzed by cold vapor atomic spectrometry. The highest mean concentration was found to be of lead, Zinc, Manganese and Chromium which were 230.5, 421.3, 687 and 167.3 Â µg/g respectively. It was concluded that the high concentration originate mainly from industrial sources as well as traffic sources. Further, the high concentration of Mn was found to originate from soil sources which were considered to be a mixture of natural and anthropogenic sources. 2.1.3 Determination of Heavy Metals content in Soils and Indoor Dusts From nurseries in Dungun, Terengganu Tahir M.N. et al.22 determined the concentrations of certain heavy metals such as Al, Fe, Pb, Zn, Cd, Mn and Cu, in indoor dusts and outdoor soils from nurseries located in industrial, town and village area found in Dungun district, which was one of the coastal towns located in Malaysia. For this study carried out in 2007, eighteen sampling sites where chosen which were nursery schools. The sampling sites were divided into three groups: the first group was at the center of the town and near heavily frequented urban traffic routes; the second group selected was found in the south region of the town and was considered as industrial area. This region had high density of petroleum chemical industry, power plant and main roads with heavy traffic loads. The Third group was village, situated at the edge of the urban area which was a quiet residential district with low volume of traffic and negligible industry. The collected samples were then digested and heavy metals concentrations in both soils and dust indoors were determined using atomic absorption spectrometer (FS 220A VARIAN). The range of metal observed were 46.9 Â µg/g for Cu, 338 Â µg/g for Mn, 4.66 Â µg/g for Cd, 130 Â µg/g for Zn, 91.7 Â µg/g for Pb and 114000 Â µg/g for Al. However, from the result obtained, it was found that the village areas had higher level of toxic metals compared to both town and industrial areas for outdoor soils. On the other hand, industrial areas had exhibited higher mean concentration of Cu, Mn, Fe, Pb and Zn in their indoor dusts which originated from infiltration of outdoor particles, dust, soils, internal ventilation system, cooking smoke, old paint and furniture materials. In general, results obtained from this study showed that some nursery schools in Dungun had high levels of heavy metals content in soils and indoor dust. It was suggested that the major source of these heavy metals in soils was due to the road vehicular emission. 2.1.4 Metals Levels in Indoor and Outdoor Dust in Riyadh, Saudi Arabia Al-Rajhi A.S. et al.3 conducted a study to determine the concentration of heavy metals in outdoor and indoor dusts in Riyadh, Saudi Arabia. In 1996 , outdoor dust samples were collected from 231 sites including various rural, suburban, and urban, motorway and two industrials sites and indoor samples were collected from 20 public community centres. The samples were digested using aqua regia and were then analyzed for heavy metals using atomic absorption spectrometer (Perkin-Elmer model 1100). The mean concentration of indoor dust were 639 and 52.9 Â µg/g respectively for lead and nickel and the outdoor dust concentrations for lead and nickel were 1762 and 43.9 Â µg/g respectively. Among all these metals analyzed, lead had the highest concentrations. This was due to the use of leaded fuel, with levels being especially high near motorways as a result of high traffic density. However, it was observed that there was a decreased in lead levels in suburban and rural areas where automobile emissions were much less than in urban areas. 2.1.5 Investigation of Trace Heavy metal Concentrations in the Street Dust Samples Collected from Kayseri, Turkey Divrikli U. et al.12 investigated the levels of heavy metal ions of the street dusts from Kayseri, Turkey. A total of 77 street dust samples were collected during the period of April 2000 till June 2000 and control samples were collected from three hills outside Kayseri that were not affected by metal sources. After digestion with aqua regia, the samples were analyzed using flame atomic absorption spectrometry. The range of concentrations of heavy metals was 84 -532 Â µg/g for lead and 49 -381 for nickel. It was observed that high levels of lead in dust were from combustion of gasoline. The highest concentration of lead (165.5 Â µg/g ) was observed around street carrying heavy traffic and the minimum concentration was 103.3 Â µg/g which was from school garden. For nickel, the source was from abrasion and corrosion of nickel containing parts of the vehicles in the traffic. The highest concentration was 57.3 Â µg/g which was observed in heavy traffic. 2.1.6 Lead Distribution in Near-Surface Soils of Two Florida Cities: Gainesville and Miami, USA In 2004, Chirenje T. et al.8 conducted a study to determine lead distribution in soil in two Florida urban areas, having different levels of industrial development and population. 240 samples were collected from three land-use classes: residential, commercial and public land. They were digested using USEPA method (hot plate digestion) and analyzed using graphite furnace AAS. After analysis of the samples, it was found that the average concentration of lead in Gainesville was 16 mg/kg while 93 mg/kg was observed in Miami. Considering Gainesville, the lead concentration increased as follows: public parks (10 mg/kg), commercial areas (18 mg/kg), public buildings (20 mg/kg) and residential areas (23 mg/kg) whereas for Miami the increased was from: public buildings (77 mg/kg), public parks (79 mg/kg), residential (102 mg/kg) to commercial areas (120 mg/kg). Hence, the higher lead concentration was found in Miami, which was mainly due to the soil properties rather than just anthropogenic factors. 2.1.7 Heavy Metal Concentrations in Street and Leaf Deposited Dust in Anand City, India Bhattacharya T. et al.6 investigated the heavy metal concentrations in street and leaf deposited dust in Anand City, India in 2011 . Street dust samples and leaf deposited dust samples were collected from five major roadways selected on the basis of traffic load, population density and anthropogenic activities and analysis for Cu, Ni, Pb and Zn were carried out. The samples were digested and analyzed using AAS (Perkin Elmeyer model). The mean metal concentration in street dust sample varied with sampling location. Lead concentration (105.4 mg/kg) in dust samples was consistently high. The high Pb concentration was interpreted as resulting from the continued use of leaded gasoline on the outskirts of the city since some petrol stations were stilling selling unleaded petrol. In addition, Pb was also used in manufacture of pesticides, fertilizers, paints, dyes and batteries. Therefore industrial sources had also contributed to Pb levels from vehicle emission. The concentration of nickel in the street dusts ranged from (56.9-75.81 mg/kg). The main source of nickel in street dust was the combustion of diesel fuel. Unexpectedly, nickel content was relatively higher, compared to other metals, in the rural area suggesting that the extensive use of diesel in three wheelers, tractors and water pumps used for irrigation in rural areas was contributing the elevated level in dust. 2.1.8 Heavy Metal Concentration in Road Deposited Dust at Ketu-South District, Ghana Addo M.A et al.1 carried out a study in 2012 to determine the metal concentration in deposited dust along the road of Ketu-South District, Ghana. Fifty sampling sites were selected from popular roads that experiences intense traffic conditions within the district. The collected samples were allowed to dry for 10 days and were analyzed by X-ray Fluorescence Analysis. The lowest metal concentration was: 0.4 ÃŽ ¼g/g for As; 284 ÃŽ ¼g/g for Cr; 18.4ÃŽ ¼g/g for Cu; 233 ÃŽ ¼g/g for Mn; 12.3 for Ni; 3.1 ÃŽ ¼g/g for Pb; and 18.2 ÃŽ ¼g/g for Zn. It was noted in a roadway which runs through a host of rural communities. The maximum concentration of Cr (9106.0 ÃŽ ¼g/g), Mn (1240.0 ÃŽ ¼g/g), and Pb (67.80 ÃŽ ¼g/g) were found in road soil samples collected from the roadway normally patronized by heavy trucks used in conveying cement products and raw materials to and from the cement factory. Therefore, much cement dusts were spread along the road as loaded cement trucks made use of the road. The source of Cu and Zn in the samples was indicated by research as tire abrasion, the corrosion of metallic parts of cars, lubricant and industrial. 2.1.9 Heavy Metal Determination in Household Dust from Ilorin City, Nigeria Adekola F.A et al.2 collected samples from 18 different locations in Ilorin, which was the capital of Nigeria, to determine the levels of lead, cadmium, nickel, copper and iron in indoor dusts. Sampling was done daily in the morning between the months June and September, 1998. The collected samples were digested and the concentrations of metals were determined using atomic absorption spectrophotometer (Pye Unicam Model 2900). The mean metal concentration in dust sample varied with sampling location. The range of concentration of heavy metals was (2.34 -10.17) mg/kg for Pb, (0.19 -1.99) mg/kg for Cu, (0.001 – 0.38) mg/kg for Cd, (0.006 -2.19) mg/kg for Ni and (28.6 -45.4) mg/kg for Fe. The high levels of concentration of Pb, Ni and Fe were mostly likely originated from sources such as emission from automobiles and fall out from wall paint. Further, the important levels of Fe observed in all locations were due to the nature of the local soil and the intensity of human activities in the various localities. 2.1.10 Water-Soluble Species and Heavy Metals Contamination of The petroleum Refinery Area, Jordan In 2002 , Momami A.K et al.16 investigated the levels of Pb, Cd, Cu, Zn, Al, Cr and Fe in street dust, soil, and plants in the Jordanian petroleum refinery. Eighty- one street dust samples, coded D1-D18, were collected from different sites such as highway, housing area, manufacturing area, main gates, loading parking area, tanker loading area and major refining units. The collected samples were dried and digested using concentrated nitric acid. Heavy metals were then determined using a Thermo Jarrel Ash Flame Atomic Absorption spectrometer, (Model Smith-Hieftje 11, USA, with SH back-ground correction. For determination of low concentrations of heavy metals, a Graphite Furnace Atomic Absorption Spectrometer (GFAAS) was utilized. The mean concentration of heavy metals obtained was as follows: Pb (77 Â µg/g), Cu (69 Â µg/g), Zn (178 Â µg/g), Fe (4510 Â µg/g), Cr (21 Â µg/g) and Cd (1.38 Â µg/g). The highest levels of lead were observed in the housing area, streets between loading parking area, the road tanker loading area and at streets near the main gate of the refinery. The high lead contamination at the housing area and at the main gate was due to automobile exhaust emission since most automobiles passed through these sites. Also fuel leaks, spills, and exhaust emissions from tankers in the loading parking area and tanker loading area was responsible for lead contamination occurring at these sites. Further, high concentrations of the other metals: Cu, Zn, Cd and Cr were commonly found in the manufacturing area, and around the major refining units. These findings indicated that materials used in manufacturing cylinders, major refining processes, leaks of oil product during loading of tankers, and motor vehicles were the primary sources of these heavy metals. Additionally, existence of CU in street dust was derived from engine wear of automobiles, while attrition of automobile tires and lubricating oils were possible sources of Zn and Cd. 2.1.11 Soil Lead Pollution alongside Some Major Roads In Mauritius In 2000 , Choong Kwet Yive N.S et al.10 conducted a study to determine the lead levels in soil alongside main roads in Mauritius which were caused mainly by vehicular exhaust. Four Mauritian roads with different traffic densities were selected for sampling. The collected samples were digested using Milestone microwave digester and the lead determination was carried out using atomic absorption spectrometer (UNICAM 929). The mean lead concentration in dust sample varied with sampling location. The highest lead concentration, 1938 Â µg/g, was found at Rd1, which was the major motorway having the highest traffic density. Further, it was also reported that the west side of Rd1 had a concentration of 786 Â µg/g compared to that on the east side (536 Â µg/g). This was due to the South- East Trade Wind which blows the lead particulate to the left side of the road. The low concentration of lead found was 12 Â µg/g, which was due to the dry weather and compact soil. It was concluded that the major sources of lead pollution in street dust was due to vehicular emission. 2.1.12 Monitoring of Pb and Ni in Street Dust Coming from Vandermeersch Street Jhurry K.R.15 conducted a study in street dust coming from Vandermeersch Street, to determine Pd and Ni concentration. Sixty- four dust samples were collected over a period of four months from August to November 2011. The collected samples were acid digested using microwave digester system and then analyzed using FAAS. The mean concentration of heavy metals was 65.4 ppm for lead and 208.2 ppm for nickel. Further, it was also reported that the left side of the road had the highest metal concentration compared to that on the right side. This was due to the South-East Trade Wind, blowing the dust particulate toward the left. The high Ni concentration observed was due to traffic density. Considering the lead concentration, it has decrease considerably since there was a shift from leaded gasoline to unleaded one. Further, other factors affecting lead level from one place to another was seasonal behavior and human activities. 2.1.13 Lead and Nickel Levels near Vandermeersch Street. Summoogum Y.P.21 carried out a study to determine the lead and nickel levels in street dust at Vandermeersch Street, Mauritius. A total of 80 samples were collected from 8 different sampling sites over a period of five months from August to December 2012. The concentration of lead and nickel were determined using FAAS after digestion in acids using microwave digester. The mean concentration of heavy metals obtained was 32.6 ppm for lead and 52.5 ppm for nickel. The concentration of nickel was explained by the increase in traffic volume, which was mainly due to abrasion and corrosion of vehicular parts. Moreover, it was seen that the left side of the road was more polluted than that of the right, showing the effect of the South-East Trade Wind which blow the dust particulate toward the west side of the road, causing accumulation. For lead, it was seen that there was significant decrease since the use of leaded gasoline was banned in September 2002 and unleaded gasoline was introduced all over the island.

Ethan Frome: Tragic figure that function

Ethan Frome: Tragic figure that functions as an instrument of the suffering of others ay cache1897 unit Four: Ethan Frome In the novella Ethan Frome by Edith Wharton, main character Ethan Frome is a man that faces many disappointments as well no self-assurance. Ethan Frome is definitely a tragic flgure that functions as an Instrument of the suffering of others In the novel. Ethan Frome overall is a very tragic tale of misery and suffering, and any of the main characters involved can be connected to that suffering.Wharton makes Ethan not only the victim, but the function of all the other characters suffering to ruly get In depth with the flaws that Ethan possesses. Zeena, Ethan FromeS wife experiences much suffering due to Ethan. Ethan spent his whole life never being able to stand up for himself. He chose to marry Zeena for the sole reason that she would end his loneliness. It could have also been the fact that he felt bad that she dedicated her life to taking care of Ethan's mom. Ne xt, Ethan decided to give Zeena a loveless relationship.Never in the text does Ethan show any sort of emotion toward his wife, nor does she show any towards him. Ethan is omewhat awful towards the one in which he personally chose to be his wife. He chooses to go to â€Å"work† rather than drive her to the doctor, he decides to pursue another woman who Is his wife's cousin, and lastly, he chooses to kill himself for the sake of his own independence and his â€Å"love† for Mattie. Zeena however, can be aggravating at times which causes Ethan to act certain ways. Zeena tragically has â€Å"hypochondria† which brings out the cold, unhappy, domineering woman who whines and complains incessantly.Ethan lets Zeena dominate him which shows his flaw of eing subordinate. These mistakes eventually lead to his fall. It Is clearly seen that Zeena uses Illness to get Ethan's attention and love he hasnt been giving. Zeena makes it hard for Ethan to show how he feels about Matti e in his heart, because when she comes around, Ethan Is blindsided by her thoughts in his head. â€Å"†¦ but there was only one thought in my mind: the fact that, for the first time since Mattie had come to live with them, Zeena was to be away for the night.He wondered if the girl were thinking of it too†¦ † (40). Another main character is Mattie Silver, who is he desired women Ethan wants to be with rather than his wife. From early descriptions of Mattie, she appears to be the silvery maiden whose arrival Into Ethan Frome's desperate life provides love and hope. Wharton describes Mattie as being a lively and happy young woman, before her suicide attempt that leaves her an invalid and a former shadow of herself. Her name, Mattie Silver, symbolizes the glistening and beauty of a piece of sterling silver.Wharton also states â€Å"The pure air, and the long summer hours In the open, gave life and elasticity to Mattie† (Wharton 60). Thls quote give Mattie the ima ge of someone with great beauty and personality. Ethan has strong feelings for Mattie and it turns out that the maiden has mutual feelings. Because she has feelings for him, and the sweetness of spirit to interest him in return, the resulting tragedies occur. She develops a catastrophic attitude. She had the mindset that if she couldnt be with Ethan, and be happy, then she doesn't want 1 OF2 sne tnen encourages Etnan to take tne slea down ana commit sulc10e wltn her.Her spontaneous and drastic emotions that are tied up with Ethan lead to much uffering. The fact that Ethan quickly agrees to commit suicide shows that he isn't really self-reliant and doesn't think for himself. Wharton shows a flaw that Ethan possesses which in turns cause much suffering for him and Mattie. Ethan Frome is definitely painted as a tragic figure in his crippled state of misery. His tragic flaw could be that he is too indebted to family, and feels too much obligation to them. This brings him home to care fo r his parents, and won't allow him to leave his wife to seek happiness.It's a good trait, loyalty, but in this case it eeps him shackled in a miserable situation, that, because he won't resolve it in a different way, leads to his tragic and spontaneous decision on the day he decides to go sledding with the women he truly desired. Although Ethan may have suffered, his suffering impacted the people around him. Ethan and his wife represent a broken relationship. It is very ironic how the pickle dish Zeena cherishes is broken. The fact that Zeena's cat breaks the pickle dish is significant. The cat is already symbolically linked with Zeena.

Health Insurance Matrix Essay

Origin: When was the model first used? What kind of payment system is used, such as prospective, retrospective, or concurrent? Who pays for care? What is the access structure, such as gatekeeper, open-access, and so forth? How does the model affect patients? Include pros and cons. How does the model affect providers? Include pros and cons. Indemnity In 1932 the American Medical Association (AMA) adopted a strong position against prepaid group practices, favoring instead indemnity-type insurance that protects the policyholder from expenses by reimbursement (Jones & Bartlett, 2007). As one of the first health policies in the U.S., indemnity plans are considered traditional health plans. Indemnity insurance plans have three options. Two of them are reimbursement plans (Howell, R., 2014). One typically covers 80 percent while the patient covers 20. The other option covers 100 percent. The third option pays the insured a certain amount each day for a maximum number of days. Indemnity plans are fee-for-service plans (retrospective). With an indemnity plan the patient pays for care. Afterwards the patient must submit a claim in order to be reimbursed. Indemnity plans are non-network based plans with open-access. This gives insured individuals flexibility when choosing doctors, hospitals, and health care facilities. No primary care physician (PCP) is necessary. No referrals are needed. Indemnity plans provide patients with flexibility and control over their medical care. No PCP must be selected. No referrals are needed to obtain services. The drawback however, is that patients must submit claims in order to receive reimbursement for services. This can take time. Indemnity plans  only reimburse services covered by the insurer. Services not covered will require full payment from the patient. Providers can require the costs for services up front to guarantee they are getting what they charge. Providers are not required to help patients with the necessary paperwork needed for reimbursement. This potentially saves providers time and resources if they decide to ask for funds in full before service. The drawback to indemnity plans is that patients may not have all the funds required to front the bill. Expensive services can detour patients from seeking care. Consumer-directed health plan Consumer-directed health plans (CDHP) were the result of public backlash against managed care and the rise in health care expenditures (Bundorf,K. M., 2012). CDHP’s were first introduced in the late 1990s. CDHP’s aim to control costs by putting responsibility for health care decisions into the hands of patients. Patients with a CDHP are required to pay for medical services in a fee-for-service type payment plan (retrospective). Patients pay for costs out of pocket until a maximum out-of-pocket limit is met. The insurance company covers additional costs after the maximum limit is reached. The insurer fully reimburses the medical provider. Unless a claim is submitted (AET), in which case only a portion is reimbursed. With a CDHP the patient is required to pay 100 percent of the pharmaceutical and medical expenses. Once the yearly deductible is met, the patient will is only required to cover a certain percentage of costs. The percentage varies depending on the provider. Of course, there are plans that cover 100 percent of their in-network costs. Patients with a CDHP gain access to a network of providers that their insurance company contracts with. The patient is not required to choose a primary care physician, and is not required to obtain a referral to see a specialist for medical care (Aetna, 2012). CDHP’s offer increased consumer control over health care dollars (Furlow, E., n.d.). Patients have better support tools (online, phone). They also have more power to make decisions. Alternatively, increased decision making  ability allows patients to forgo care. This can delay diagnosis and treatment. Ultimately, reducing the effectiveness of the plan altogether. Potential for higher payment amounts at time of service. Alternatively, there is a potential for greater debt amounts. Larger debts will make it necessary for health care providers to be more aggressive for collections. Providers will also encounter increased staff costs in order to follow-up with patients in advance of treatment, as well as in subsequent collection efforts (Fifth Third Bank, 2008). Point-of-service HealthPartners of Minneapolis pioneered point-of-service (POS) plans in 1961, but the concept took 25 years to get off the starting blocks (Dimmit, B., 1996). In 1986 CIGNA Healthcare launched Flexcare, the first POS plan. By 1995 forty percent of employers with at least 200 employees offered POS plans. Providers within a point-of-service network are usually paid a capitated fee. The fee is fixed and does not alter regardless of services rendered. POS plans operate using a prospective payment system. Insurance companies reimburse providers an agreed amount that is decided before a patient receives services. Patients are responsible for paying a co-payment when visiting a doctor. After the patient is seen, the provider submits claim forms to the insurer for the services rendered. Once the claims are processed the insurer will reimburse the provider (Austin & Wetle, 2012). If a patient goes out-of-network, they are required to pay the provider in full. Afterwards the patient can submit a claim for reimbursement. Point-of-service insurance plans utilize gatekeepers. This is the primary care physician for the insured individual. Patients are not required to obtain referrals from their primary care physician to seek medical care services from an out-of-network provider. Although it is recommended. If a patient goes out-of-network they’ll typically have to pay the majority of costs. Unless the primary care provider makes a referral to an out-of-network provider, in which case, the medical plan will pick up the tab (Small Business Majority, n.d.). Patients can easily go out of network. They have geographic flexibility that allows them to access doctors virtually anywhere. Compared to an HMO, patients have more choices. On the other hand, deductibles can be costly (Gustke, C., 2013). Provider’s in-network require a small copay. Out-of-network providers require patients to appease a high deductible. POS’s might not be worth it if you never use out-of-network providers. Out-of-network care requires patients to submit their own claims. Reimbursement can takes months to recover. POS’s are very similar to HMO’s and PPO’s. POS plans may have restrictive guidelines for health care providers. Some POS plans require the use of a primary care physician (PCP). PCP’s are responsible for routine care, all referrals, obtaining precertification for in-network services, and filling out paperwork for in-network care. Preferred provider organizations Preferred provider organizations (PPO) originated in the 1970’s. PPO’s were created from the rules of fee-for-service care. PPO’s steer employees to cooperating doctors and hospitals that have agreed to a predetermined plan for keeping costs down (Kiplinger, 2014). PPO’s negotiate a contract with providers, specialists, hospitals, and pharmacies to create a unified network. The providers within the network agree on a set rate to provide health care services at a lower rate than they normally charge for services (Kiplinger, 2014). PPO’s use a prospective and retrospective system. This is to ensure that the provider is only doing medically necessary tests and treatments for the injury being claimed, rather than trying to gain a larger reimbursement. With a PPO the insured pay a deductible to the insurer. After the deductible is paid, the insurer then covers any additional medical expenses incurred. Preventative care services are not subject to the deductible (Kiplinger, 2014). Some patients are required to make co-payments for certain services, or are required to cover a percentage of the total cost for medical services  rendered. PPOs are open-access plans. PPOs allow patients to seek medical care with any provider, whether in-network or out-of-network. Patients are not required to obtain a referral, they are also not required to select a primary care physician. Patients with a PPO plan have the freedom to choose almost any medical provider or facility they want for their medical services. If a patient seeks medical care within their network, their costs will be relatively low. Patients are not required to choose a primary care physician. They are also not required to go through their primary care physician to see a specialist if said specialist is in the PPO network. On the other hand, when a patient receives care from a provider outside of their PPO network, costs can be higher and sometimes not covered at all. For in-network providers, PPO’s guarantee a large amount of patients. Most patients would rather receive care in-network opposed to paying more for out-of-network. The prospect of a larger amount of patients enrolled in the PPO can generate more income for the provider. On the other hand a provider can lose money if they are not fully reimbursed for medical services rendered, because they are not paid a capitated fee. Health savings account Health savings accounts (HSA) were signed into law in December 2003. HSA’s were created by a provision of the Medicare Prescription Drug Improvement and Modernization Act (Stevens, S., 2005). HSA’s are used in conjunction with high-deductible insurance plans to help offset the costs of medical expenses. Health savings accounts use a fee-for-service type payment plan (retrospective). When a patient receives medical care they are responsible for paying for the medical services. Once their high deductible insurance maximum is met, the insurance company will then cover any additional medical expenses. With a HSA the patient is responsible for medical expenses. Since the patient is required to have a high-deductible insurance plan in order to qualify for a health savings account, their own personal money is used to pay for the coverage. On average a high deductible begins around $1,100 for individuals  and $2,200 for family plans. Money inside of an HSA is used to pay for expenses. This money is tax free and can be used to cover many other additional qualified medical services. Health savings account plans are open-access. The patient has the freedom to choose their medical provider and facilities are their own discretion. Referrals are not required and there are no networks from which a patient must choose from. Patients with a HSA have the freedom to manage their accounts and finances themselves. Patients control how money is spent, and have the freedom to choose their place of care. Any money deposited into a HSA is theirs, even if an employer contributes to it. The patient is not required to pay taxes on any money that is in their HSA, or any money used on qualified medical expenses. Potential disadvantages for patients include unpredictability of illness and budget. If money withdrawn from the HSA is used for nonmedical expenses it will be taxed. Fines can also occur. A high deductible can be difficult for some to afford. Providers benefit from direct payments received from patients. Eliminating the middle man saves time and resources. On the other han d, this makes patients more consciousness about the services they use. Some patients may opt out of treatment to avoid expense. References Austin, A. & Wetle. V. (2012) The United States Health Care System, Combining Business, Health, and Delivery. (2nd ed.) Upper Saddle River, NJ: Pearson Education Barsukiewicz, C.K., Raffel, M.W., & Raffel, N. K. (2010) The U.S. Health System: Origins and Functions. (6th ed.) Mason, OH: Cengage Learning Bundorf, K. M. (2012) Consumer-Directed Health Plans: Do They Deliver? Retrieved from http://www.rwjf.org/content/dam/farm/reports/reports/2012/rwjf402405 Aetna. (2012). Summary of Benefits and Coverage. Retrieved from http://www.aetna.com/health-reform-connection/documents/SBC-Plansponsorflyer-Self-funded.pdf Furlow, E. (n.d.) Exploring Consumer-Directed Health Care. Retrieved from https://www.ciab.com/WorkArea/DownloadAsset.aspx?id=318 Fifth Third Bank. (2008). The Impact of Consumer-Directed Health Care on Providers. Retrieved from https://www.53.com/doc/cm/rc-cdh-provider-impact-10012008.pdf Stevens, S. (2005). Pros and Cons of Health Savings Accounts. Retrieved from http://www.forbes.com/feeds/mstar/2004/04/08/mstar1_11_14978_132.html Kiplinger. (2014) What to Know About Preferred-Provider Organizations. Retrieved from http://www.kiplinger.com/article/insurance/T027-C000-S001-preferred-provider-organizations.html Dimmitt, B. (1996). Can Point-of-Service Go The Distance? Retrieved from http://av4kc7fg4g.search.serialssolutions.com.ezproxy.apollolibrary.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Can+point-of-service+go+the+distance%3F&rft.jtitle=Business+and+Health&rft.au=Dimmitt%2C+Barbara&rft.date=1996-08-01&rft.pub=Medical+Economics+Inc&rft.issn=0739-9413&rft.volume=14&rft.issue=8&rft.spage=42&rft.externalDocID=10005483 ¶mdict=en-US Small Business Majority. (n.d.) Group Coverage Options. Retrieved from http://healthcoverageguide.org/part-one/group-coverage-options/#Point-of-Service+Plans+%28POS%29 Gutske, C. (2013) Pros and Cons of Health Insurance POS Plans. Retrieved from http://www.bankrate.com/finance/insurance/pros-cons-health-insurance-pos-plans.aspx

The Role of Technology in Management Leadership Essay

The Role of Technology in Management Leadership Over the last sixty years of business activity, there has been new ways and means of conducting business through something we call technology. Technology is the advancement and use of electronic devices and other high-tech equipment to produce and progress knowledge into the future. Advancements in technology have affected management leadership in many ways over the last sixty years. New technology has altered leaders’ consciousness, language, and the way they view their organization. Technological advancements have made things easier for those in management leadership roles. But as with anything, there are positive and negative aspects of technology on leadership. Some of the positive†¦show more content†¦In addition, many of the newest handheld models can be wirelessly networked, which means leaders can send and receive e-mail and surf the Web without having to synch up to a computer. Video-conferencing is a three-dimensional, top-quality audio and video virtual rea lity telecommunication that will allow leaders to examine minute objects through remotely controlled microscopes. Videoconferencing technologies use a compressed video system to transmit information from one location to another either via the Internet or a telephone line. On a more negative note, when leaders are using some of the technological advantages as mentioned above, they run the risk of reducing the privacy of their organization. Privacy is a privilege that we take for granted in this country, yet it is strongly threatened by advances in technology. The ability of political and economic institutions to discover private information about individuals and organizations is overwhelming. Some of the various ways that information about an organization’s activities can be collected without their knowledge or consent are: through cookies, browsers, search engines, electronic commerce, E-mail, and spam. The threat of spyware and other security threats are unlikely to be eradicated. Hackers, criminals, and others with ill intent will always attempt to avoid the intentions and protections of users in an effort to exploit PCs andShow MoreRelatedThe Role of Technology in Management Leadership1882 Words   |  8 Pagesthrough something we call technology. Technology is the advancement and use of electronic devices and other high-tech equipment to produce and progress knowledge into the future. Advancements in technology have affected management leadership in many ways over the last sixty years. New technology has altered leaders consciousness, language, and the way they view their organization. Technological advancements have made things easier for those in management leadership roles. 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