Waiting lists in the NHS clearly demonstrate that it is inefficient Essay Example

Waiting lists in the NHS clearly demonstrate that it is inefficient Essay In 2002, public expenditure on health represented 7.7% of GDP. At the same time, over one million people were waiting for treatment on the NHS.1 Through a regression analysis with a sample size of over ten thousand, T.Besley et al found that if the long term waiting list were to rise by one per thousand, then there would be a 2% increase in the probability that an individual.would buy private insurance. It has therefore been shown through regression studies that consumers of health perceive quality in the NHS through waiting times. Given that taxation remains the primary method of funding the NHS, the fact therefore, that waiting lists do exist remains a cause for concern to many people as they question how their resources are being allocated. In this essay, I will principally discuss why waiting lists exist at all, and consider the related efficiency arguments. According to this aim, I plan to dispel the thought that waiting lists are altogether inefficient. When applying economics to any area in an efficient area we usually consider two variables; price and output. In this respect, the NHS can be considered an anomaly with respect to economics as resources must be allocated without the price mechanism. It can thus be seen on a very basic level why waiting lists might exist. Consider the following diagram:- Figure 1. We will write a custom essay sample on Waiting lists in the NHS clearly demonstrate that it is inefficient specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Waiting lists in the NHS clearly demonstrate that it is inefficient specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Waiting lists in the NHS clearly demonstrate that it is inefficient specifically for you FOR ONLY $16.38 $13.9/page Hire Writer As far as we are concerned, in the NHS, there are no costs of treatment. The NHS will face a demand curve, D1 and its patients will consume up to the point Qnhs. Were there an efficient price mechanism in place, it can be assumed that the optimum quantity would be at OQ*. It is thus the case that in the NHS there exists excess demand to the degree Qnhs OQ*. This excess demand can be simply thought of as the level of waiting lists. Before we can discuss fully whether waiting lists are efficient we must ask what efficiency is in the NHS. I will asses efficiency in the NHS predominantly around the concept of Pareto efficiency. Pareto defined the economically efficient outcome in society as being a situation where it is impossible to improve the lot of any person without hurting someone else. This implies allocative efficiency as there is the correct application of resources to each person. According to a single market, in this instance health, we can infer that this means that marginal benefits equal the marginal cost of consumption. We may also consider productive efficiency. That is that output is produced at minimum possible cost. Given that there is no price mechanism in the NHS to equate supply with demand, consumers are not deterred from using services as they face zero monetary expense. The main restrictions to access are formed through waiting lists. But why must they exist at all? A good answer to this question is provided by Buchanan. It is shown in the following diagram:- Figure 2 (Figure taken from Are waiting lists inevitable? A Street, S Duckett.) The x axis represents the level of private health provision. The individual with budget constraint AB and indifference curve I2 will purchase OQ1 health care. Given the introduction of an NHS, the x axis must now represent the level of social health care provision. Assuming that the individual transfers to public health care, he now has to purchase health care for others (according to the tax system) in contrast to the previous, private system in which he was only concerned with himself and his family. This will alter his indifference curve, I2-I2 , and less health care will be demanded, OQ2. If this is the case across the market, the consequence of public health care is that there will be a smaller aggregate expenditure on health care as compared to a private health care system. In addition to these problems, there will also be an increase in demand. In the NHS there are no user charges, as explained earlier. The consumer of public health care will therefore consume up until the point where the marginal utility of health care is zero. This will result in the optimum resource demand being OQ3. This restriction in supply and expansion of demand leads Buchanan to suggest that waiting lists are endemic to the (NHS) system. Since most potential patients cannot afford private health provision, they have a simple decision, be treated (and wait) or not be treated. Therefore, assuming that society is rational, the prospective patient will wait until he tops the list to get treated. This implies that the Pareto efficient outcome in a single market does not exist here and that waiting lists do suggest that the NHS is inefficient. The marginal patient is not the patient that equates his marginal cost of waiting with the marginal benefit of treatment, but the patient that perceives any benefit whatsoever from the treatment that he will receive at the future date. This suggests that as long as the demand curve is unchanged, the potential consumer surplus from inpatient treatment is not dissipated by the wait for treatment.2 Another reason why long waiting lists are inefficient is that as the waiting time increases, resources are allocated away from treatment towards administrative costs. This implies that as waiting times increase the service displays decreasing returns to scale rendering the quality of service smaller. Ideally, the hospital should aim to allocate its budget to the point at which it is indifferent between further3 increasing admissions and marginal wait reduction. A significant reason why this problem persists is that often, hospital managers cite increasing waiting lists when negotiating the hospitals budget with the government. In such situations in the past, the government has displayed a positive willingness to pay in reaction to increasing waiting lists, and as a result hospitals havent given a great enough weight to reducing lists, but rather to increasing admissions. It might however be unfair to judge the NHSs level of efficiency on its waiting list levels. Firstly, it might be the case that where there are areas that show a high proportion of people that are privately insured, lobbying for shorter waiting lists would decrease and this could lead to a positive correlation between private insurance and waiting lists. But why might this be? One of the greatest problems with the NHS is that of Supplier Induced Demand (SID). In terms of health care this refers to the extent to which a doctor provides or recommends the provision of medical services that differs from what the patient would have chosen if they had the same information and knowledge available as the doctor. Would a patient, for example, have given up an afternoon in the workplace if they had known on referral that the specific treatment for a complicated disease was a plaster to the toe? This idea falls in line with the fact that many remuneration systems are designed so that the doctor receives a greater income when they give a greater amount of services to each patient. This is borne out by a study by Krasnik et al (1990) who found that after GPs in Copenhagen had their remuneration methods changed to a fee-for-service basis, their activity increased until they attained their target incomes at which stage activity fell, suggesting SID. Might it be the case that waiting lists merely reflect the greed of GPs and the perverse incentives offered to hospital managers, rather than the actual inefficiency of the NHS? For certain waiting patients, it is evident that inpatient treatment is needed now, or not at all. A wait of any duration will be of no help at all. In the current NHS, priority is given to these patients. In the UK, waiting lists tend to build up for delay able cases5 In respect of this, waiting lists may simply represent a stock of work for doctors, ensuring that their scarce and skilled resources are utilised in the correct instances. It is also argued by Cullis and Jones that a waiting list allows for a balance of cases of differing nature and complexity, facilitating the teaching function of many hospitals. Taking these two points into account it may be argued that waiting lists optimally use the scarce resources presented to them, implying that waiting lists might actually facilitate efficiency. There is no doubt that increasing waiting lists are more than likely to indicate a poor performance in terms of economic efficiency. Between 1997 and 2002, expenditure on public health grew in total by over 50%. At the same time, waiting lists only fell by 15%, suggesting that there is a large misallocation of resources throughout the NHS and an undesirable level of efficiency. That is if we are looking to waiting lists as the key indicator of NHS performance. The weighting given to this area of NHS performance seems unfair and misinformed. It is my opinion that a reasonable waiting list actually gives rise to an efficient allocation of resources in a system that cannot naturally do so through the price mechanism. Undoubtedly lists can become unhelpfully large. In these cases I would argue that reforms such as buyer contracts could be easily be implemented that would prevent lists from becoming too large through the perverse incentives provided by the government to use waiting lists as a bargaining tool.

feminists perspectives on fema essays

feminists perspectives on fema essays The concept of female criminality is one which has until recently been given very little consideration to in terms of its unique needs and characteristics. Like most areas of research, the study of criminology is one which until recently has been dominated by male researchers which seemed logical in the sense that the majority of crimes committed were by men. Therefore any crimes committed by women were just explained using the theoretical concepts created for men. It is only since the beginning of the 1960s that feminist groups have taken an interest in the roots and causes of crimes committed by women. The reason for this current interest is the realization that crimes committed by women cannot simply be understood using theories created to explain male activities. To explain the phenomena of female criminality, many theoretical perspectives have been put forth. Rather than focusing on physiological and biological causations, which were the main ideologies proposed in the past, contemporary feminist theorist are now analyzing female criminality through an economic and social context. In doing so, feminist criminologists have put forth various theories to serve as an aid in explaining the rise of female criminality in Canada. A very well known criminology theory that was presented by Caesare Lombroso in the late 19th century was the theory of the Female Offender (Bowker, 28). In a time period when women were recognized as individual beings and respected for their needs and rights, Lombroso proposed the theory that female criminality was due to biological abnormalities. He based his research on womens prisons and courts that he had visited and on the measurements he had taken of the womens various body parts. In his findings, Lombroso noted that that the majority of the female inmates had physical abnormalities such as heavy lower jaws, large nasal spines, simple crania...

Art Essay Example | Topics and Well Written Essays - 500 words - 2

Art - Essay Example He was recognized for his outstanding work in art and had won numerous awards and honors. Among these honors he had won the Master Artist Award (2000) from Artists of America. Description The painting I have chosen from the William Hook’s collection of art is the â€Å"Autumn Road† which is a 24† by 18 inch painting depicting a long road with trees and bushes on either side during the Autumn season. The colors used on this canvas are browns, orange, yellow and dark green that clearly portrays the autumn season. Commenting on the use of acrylic paint, Hook states – â€Å"Make the shortcomings of acrylic the benefits.† (William Hook) He makes use of the minimalist technique in this art work while communicating the grandeur of the landscape. Hook holds the opinion that any finished painting is an amalgamation of different techniques but, ‘impasto is achieved through light strokes of paint with no additives.’ (William Hook) Meaning The meani ng depicted in ‘Autumn Road’ is one of calmness and spirituality. The artist portrays his serenity through his work. The landscape shown is silent and calm and conveys the message of peace of the artist.

Chapter Summery Essay Example | Topics and Well Written Essays - 500 words

Chapter Summery - Essay Example The objective of this book is to introduce the Sheltered Instruction Observation Protocol (SIOP), which has been proven to be an effective method of teaching learners of English not only language but content as well. The model has resulted in increasing the chances of the learner to succeed in school. Middle school teachers have already been trained to implement the SIOP model not only in urban schools but also in suburban and rural schools across the United States. It is notable that the SIOP model is not an inflexible framework that cannot be customized but rather a framework that can be adapted to teach any course or subject. With the SIOP model the teacher has to adhere to a list of fundamental instructional principals that are essential to meet the unique language development needs of the student. Once the principals are adhered to the teacher is then free to be creative when designing the delivery of the particular lesson. As the reader proceeds through the book he/she will have many opportunities to try out different methods to supplement, improve and even enhance his/her method of teaching and instruction delivery.

The Compulsory Process Clause Of The Sixth Amendment Essay Example for Free

The Compulsory Process Clause Of The Sixth Amendment Essay The sixth amendment to the U. S. Constitution guarantees the defendant â€Å"compulsory process. †1 For this provision was ignored, until the Supreme Court gave it life in Washington v. Texas, 388 U. S. 14 (1967). One night, Jackie Washington learned a girl he was dating, Jean Carter, was seeing another boy. Angry, Washington and Charles Fuller got a shotgun and drove to Carter’s house. Leaving others in their car, Washington and Fuller got out, with Washington carrying the shotgun. Moments later, the shotgun was fired, killing Carter’s boyfriend. Fuller and Washington ran to the car, with Fuller now holding the shotgun. Fuller was charged with murder, convicted, and sentenced to 50 years in prison. Texas then brought Washington to trial for murder. At his trial, Washington testified that as he approached the house, he realized that what he was doing was crazy, and decided to go back. Fuller, drunk, grabbed the shotgun, saying he was going to shoot someone. Washington tried to get Fuller to leave, but Fuller insisted on going on. Washington then ran towards the car. He was running away when the shotgun was fired. At the trial, Washington then tried to call Fuller as a witness to corroborate his story, but the prosecution objected. Under a Texas law, if the prosecution had called Fuller as a witness against Washington, he could testify, but Washington was barred from presenting Fuller as a witness. Fuller, who was present in the courtroom, was not allowed to testify. Washington was convicted of murder. Washington appealed, arguing that he had not been accorded his right to compulsory process. Texas responded that Washington had been accorded all compulsory process entitled him to. Because Fuller was in prison at the time of the trial, Washington’s attorney had issued a subpoena to have him appear in court to testify. Texas authorities had complied with the subpoena. They had brought Fuller from the prison to the court, so that he was in the courtroom, though barred from testifying. Texas insisted that this was â€Å"compulsory process. † The Supreme Court ruled unanimously that this was not constitutionally sufficient. Compulsory process would mean little if it gave the defendant only the right to bring to the courtroom persons who could not testify. The Constitution did not make such hollow gestures. For the compulsory process clause to be meaningful, the defendant had to have the right to have his witnesses appear and testify, so that the jury could hear what the witness had to say. Texas justified its rule by arguing that its statute was meant to protect against witnesses who would lie for one another. In this instances, Fuller had been convicted. But what if Fuller had been found not guilty and then in Washington’s trial confessed his own guilt while exonerating Washington. However persuasive this argument seemed, the Court rejected it, insisting that issues of the believability of a witness were for the jury to decide. A rule which denied a defendant a right promised in the Bill of Rights could not stand where it was based on the unproved and unprovable presumption that any given class of defense witnesses were presumed to be unbelievable. If Fuller was such an unbelievable witness if he was testifying for Washington, why was he presumed truthful if testifying against him? The better policy, the Court insisted, the policy which the Constitution required was to allow all witnesses who had relevant and material evidence to testify, letting the jury find the truth. This case, Washington v. Texas, made the concept of compulsory process as guaranteed by the sixth amendment an important part of a modern justice system.

Lethal Tools of Our Past-Weapons of The Frontier :: essays research papers fc

Lethal Tools of Our Past- Weapons of The Frontier   Ã‚  Ã‚  Ã‚  Ã‚  A starving man paves his own highway with the calloused soles of his hunger. Out on the untamed wastelands, forests, and prairies it was the way of the gun, the knife, and the axe for all that managed to survive. And survive these brave men and women did with a sheer will of endurance that the pampered of today’s world has not come to know even the shadow of. In our modern comfort we live in what legacy these bold souls carved out of this nation, and much of the thanks we must give is passed to the sweat-hewned implements of their survival, the weapons of the frontier.   Ã‚  Ã‚  Ã‚  Ã‚  Scourging the countryside for this evening’s meal or simply keeping wary of impending danger, one often felt naked without a trustworthy gun at their side. A firearm often made one feel invincible, for the power of a bullet could protect the weakest and cowardly from even the strongest and fiercest of animals and people. In it’s use it proved to be an action that spoke louder than words, many a quarrel has been put to rest through this instrument, whose music is often not one of good cheer.   Ã‚  Ã‚  Ã‚  Ã‚  The rifle and the coveted shotgun, literally brought home the bacon. With sleek models such as the Winchester .44 in 1873, accurate targeting sights increased a hunter’s ability to take down his prey, even from large distances, often exceeding 200 yards. The other weapon of choice, the shotgun, did not boast a straight, clean shot, but had the capacity to tear anything to shreds in a single blast. A short barrel provided the advantage of a wider blast range and easier handling (Trachtman et al 50). In many battles, the shotguns were often preferred for their simplifying features.   Ã‚  Ã‚  Ã‚  Ã‚  In the frequently lawless country that the United States had become, a quicker solution for combat was deemed necessary. It did not take long for such handguns as the 1873 Colt Peacemaker to emerge as the weapon of choice for gunfighter, cowboy, sheriff or civilian. Fighting men everywhere considered the peacemaker’s balance and durability superior to that of other revolvers of the day, and they expressed their appreciation by clamoring for a variety of versions – some decorative or modified for a fast draw, others were plain, but all were lethal (Trachtman et al 43). With a growing consideration of violence, many Americans rushed to buy them in large quantities, often through the mail.

Evolution as Fact & Theory` by Stephen Jay Gould Essay

This article talks about evolution as it relates to science and religion, philosophically. Gould talks about the fact that the arguments for creationism and evolution have not changed much, the science and religion are the same. He links the recent debates opposing the theory of evolution as the result of right wing politics that has taken hold of today’s society and political world. Gould states that today’s politicians talk about â€Å"scientific creationism â€Å"as if it is based in science. The creationists also jump on the term â€Å"theory â€Å"when used by evolutionist as if theory implies proof of guesswork, â€Å"only theory†. Gould explains the term â€Å"theory† as a string of ideas and facts. He provides examples of widely accepted theories in an attempt to debunk the creationist objection to theory. He provides similar explanation of the term â€Å"fact†. Darwin’s theory and detailed explanation are reviewed in the article, as this is central to today’s debate regarding creationism versus evolution. Gould’s view is that creationists attempt to argue against evolution is based entirely on arguing rhetoric. They use an argument style of Popper’s, which focuses on falsifying the evolutionist claims. Gould asserts that what the creationist lack is the ability to assure proves their own principles of creationism. Gould concludes that what keeps creationists firm in their belief system is dogma, not science. Thomas S. Kuhn – The Structure of Scientific Revolutions Like Gould, Kuhn takes on the debate between science and dogma. Kuhn is a scientist, clearly a believer in the scientific process though he takes pains in his article to examine the issues raised by proponents of dogma. Kuhn also believes that the opposition to evolution is based on poking holes in theories and finding loopholes, rather than convincing one with actual science. This article is largely focused on disproving dogma and supporting the scientific method. Kuhn’s overall belief as expressed in the article is that scientific theories always win arguments with dogma. This work includes a discussion on experience and perception and the relationship to presupposition. Kuhn reviews the process of scientific theory and discovery, and the philosophy behind the process.