Social Media The New Anxiety Essays - Psychology, Psychiatry, RTT

Social Media: The New Anxiety Social media is beginning to control not only our lives but also our time. Controlling our lives by what we may do everyday including our job and our relationships with friends, coworkers, and loved ones. Controlling our time by how we spend the days of our life. Social media is cutting into our lives and time by beginning to be the center of attention meaning that it is our main focus . Social media has become a large part of our world and not all of it is negative but there are some very negative effects that social media has on our population. Social media can cause many people to struggle with body image, popularity issues, separation issues, and the fear of missing out. These eventually can lead into anxiety. This type of anxiety is called social media-induced anxiety. Social media-induced anxiety can affect all ages but affects the youth and young adult population most. Social media is a large cause in anxiety and it needs to be controlled. Nomophobia. The fear of being out of contact with a mobile device or phone. When this phobia occurs, many freak out and panic. Some might even have panic attacks or throw fits. From experience, many of my younger cousins and family friends cannot go without their phones. They get very upset. I always ask them why they cannot go without their phones and it never fails for them to say that they have streaks with people on snapchat and that they must see what everyone else is doing. Most people cannot even be away from their phone when they are sleeping. It is hard to leave the online world out of reach at any time and this is the main source of how our population starts to become anxious. This feeling of uneasiness that my family members and many members of society feel when they are unable to access the online world can then lead to disconnection anxiety. This loss of connection could be caused by an internet outage, a trip to a place that might not have wi-fi, the experiment of trying to reduce the amount of time they spend on the internet. This could cause all ages discomfort and it could range from mild to very severe. Tarsha states that "Social networking technology has given rise to a unique form of anxiety in the adolescent population: the fear of missing out ( FoMO )." (The Role of Existential Therapy In The Prevention of Social Media-Driven Anxiety 382). FoMo is when people desire to know and be connected to what others are doing. This is a large portion that adds to social media-induced anxiety because the youth are always wanting to know what their friends or even enemies are up to. They are always wanting to one up the other which could not only cause anxiety and sadness but hatred and evil. This can be caused by a void they might have that technology and social media fills for a short time. It can also add a lot of pressure due to the fact that the teens are constantly trying to have the better or best post. "That's what's annoying about social media! I get frustrated that I have to find just the right picture and post it on just the right platform. There's so much unnecessary pressure, and people take it so seriously, including me. Sometimes I'll just be like, Why am I doing this? It's an app! Now I've started to share only if it's to spread something happy going on."-Kiana. ( Viggiani 100) Because many people think like Kiana, social media has become about how happy and well everyone's lives are going. Now they might not be as obsessed with posting perfect pictures but they redirect the anxiety to making sure they are happier than their followers or worry that they do not have a good life. As they scroll through their social media all they see is how fantastic someone's vacation was or how perfect someone's family and friends are. It is impossible for someone to be happy all the time or even have good things happen to them consistently, but it

Was Catiline a terrorist essays

Was Catiline a terrorist essays What exactly is a terrorist? If it is one who instills fear in others, then one can say that our professors are terrorists. In order to be begotten with this title, the fear one instills must be accompanied by violent action against civilians or rape and murder, or kidnapping and murder for his own political purposes. Cicero, then, would define Catiline, with all his plotting against the senate, as a terrorist. The corruption of youth, the desire for murder, the raping and pillaging associated with his character, and the plans to violently attack the senate and kill all the consuls for his own political gain, make Catiline a terrorist. At the start of his first speech, Cicero compares Catilines plotting to the actions of other contemporaries crimes. In section 3 of this speech, (an vero... sua occidit. In Cat. I.1.3) Cicero insists that, if Tiberius Grachus was killed for treasonous activity (by slightly undermining the Constitution) by a private citizen, why is the senate still tolerating Catiline, who wants to destroy the whole world with fire? If Gaius Servilius Ahala was killed for plotting a revolution, then Catiline could be view as the same type of enemy to the state, for his plotting. But what of the actual actions that Catiline committed? What crimes did he commit that would have defined him as such a monster and terrorist? According to Cicero, there is not one positive thing that he did do. He openly attacked the entire republic, and brought forth destruction and ruin for the temples of the gods and the houses of the city and the lives of all the citizens. According to Cicero, Catiline alone was responsible for the downfall of all of Italy. (nunc iam... et vastitatem vocas. In Cat. I.V.12) This attack on the innocent citizens and civilians is what makes Catiline a terrorist. Cicero also claims that for many years, there has not been a single crime committed that Catiline wasnt responsibl...

Media Ethics Essay Example | Topics and Well Written Essays - 1500 words

Media Ethics - Essay Example For Kant, principles of reason or a system of clear-cut needs is where morality is rooted in since every individual has the ability to reason. No matter what culture or society a person belongs to, these needs apply. Per Kant, every individual has an obligation to discern what the right conduct is in a given situation by exercising his mind. As much as an action's universal and logical application, the ultimate arbiter of correctness are not necessarily the consequences of one's actions. Per Kant, sense of duty requires every person to acknowledge another person's rights. This also asserts that the general satisfaction of many people cannot overshadow moral claims (Solomon, 127-129). Utilitarianism, on the other hand, asserts that the greatest good for the greatest number is the utmost legacy (Christians, Ferre, and Fackler, 11-13). It is totally contradictory to Kant's ethics model. It maintains that every person should have the consideration to act for his own benefit if it will also benefit the society as a whole. In pluralism, acknowledging the opposing ethical principles present in a diverse world is the ethics model. These competing ethics principles are called duties (Patterson and Wilkins, 12). These duties can be identified as not causing harm to other people, personal development, beneficence, integrity, appreciation, and loyalty. This vivid viewpoint for reflecting the every day challenges numerous professionals deal with and for acknowledging the several roles various individuals bear is praised. An individual recognition of the distinction between duty proper and prima facie duties is required in this ethics model. Duty proper involves particular awareness for the introduction of new or unusual situations and challenges while prima facie duties can be taken as daily responsibilities each person decides to advocate. Putting social justice at the core of its guiding principle is the communitarianism ethics model (Patterson and Wilkins, 14). As component of the human condition, it maintains that every person should be sensitive to the corollaries of their behaviors both worldwide and within a society (Christians, Ferre, and Fackler, 14). This ethics model highlights the dynamic relationship among social, financial, judicial, and biological systems and centers on the interdependence of people. Experts state that it is a framework exceptionally relevant in assessing the function and operation of the media in society. It increases the combined achievements that the media and their Surname 3 organizations have and silences the rivalry among media organizations in the society (Patterson and Wilkins, 15). 2. An example case study of information ethics is in chapter 2 of the Media Ethics book entitled "The New York Times vs. Wen Ho Lee." It is all about responsibility in gathering of information, biases, and political agenda. The investigative reporters failed to gather sufficient information that would allow them to weigh any possible biases that may be intentionally or unintentionally included in the reports. Also, political contexts that may have possibly hindered obtaining the actual and complete facts were not thoroughly investigated. It was a major blunder on the side of the publication at the expense of the "victim." They reported a major case against a Chinese-American without a thorough and independent investigation on their end. Their

Revenue Recognition Assignment Example | Topics and Well Written Essays - 250 words

Revenue Recognition - Assignment Example International Financial Reporting Standards don’t have many requirements on revenue recognition. IAS 18 and IAS 11 are international accounting standards that focus on revenue and construction contracts respectively. The standards are difficult to understand and application in a situation. They provide minimal guidance concerning revenue recognition used for multiple arrangements. FASB and IASB has set new accounting rules designed to assist converge global standards. The current and proposed standards will change how companies in the United States recognize their revenue on their financial and statements (http://www.fasb.org/intl/convergence_iasb.shtml). The proposed standards will have some different effects on various companies. The effects may include changes in the amount of deliverables of the contract. The standards will affect the manner in which revenue is allocated to different deliverables. These changes affect key financial measures for companies in the United States (http://www.ifrs.org/News/Press-Releases/Pages/leases-exposure-draft-August-2010.asp). Companies in the software’s industry have specific guidance that enables them to run efficiently. Proposed standards provide software’s companies with an opportunity to develop their company with regard to the management and control of their financial statements. Companies will find it hard to market their products in a sensible manner to the company and get a positive reflection in the financial statements (http://proleasesoftware.com/fasb-lease-accounting). Financial Accounting Standards Board in conjunction with IASB is going to develop new accounting standards on the recognition of revenue from contracts. They are attempting to converge financial standards to create a single standard that will apply across various industries. The action will improve revenue recognition rules and replace industry specific practices that are difficult to sustain. The main aim of

A Rose for Emily Essay Example for Free

A Rose for Emily Essay The short story begins by telling the end of it; the story begins with the funeral of the aristocratic Miss Emily Grierson during the time period of the civil war. The funeral turnout so big, the whole town of Jefferson attended. The town felt responsible for Miss Emily because they felt that she was a â€Å"tradition, a duty and a care; a sort of hereditary obligation upon the town† (287). â€Å"The men of the town respected Miss Grierson and viewed her as a fallen monument† (287), whereas the women of the town haven’t been in the house for years and was viewed by the narrator to have attended the funeral just to get a peek of the inside of Emily’s home to see how she lived. The house sits on a street that was once the town’s most prestigious areas. With all the other homes replaced with garages and cotton gins Miss Grierson’s house was the last one standing. The house was described as â€Å"a big, squarrish frame house that had once been white, decorated with cupolas and spires and scrolled balconies in the heavily lightsome style of the seventies, set on what had once been our most select street† (287). Now, time has taken toll, and neglect of the maintenance has distorted its once beautiful structure. The main conflict in the story was Emily facing reality, she didn’t know how to let go of her past â€Å"I have no taxes in Jefferson. Colonel Sartoris explained it to me. Perhaps one of you can gain access to the city records and satisfy yourselves† (288). Agitated by her tactics, the town is getting tired of taking care of her, â€Å"So the next day, â€Å"She will kill herself†; and we said it would be the be st thing† (291). The townspeople think she is stuck up and arrogant because she thinks that everything revolves around her. Isolation from the society caused her to become depressed, unhappy and crazy, leading up to her destroying Homer. Emily was a heavy set woman â€Å"She looked bloated, like a body long submerged in motionless water and of that pallid hue† (288). She was an old, secretive woman, who was devastated and alone in a growing society, forcing her to stay in her role. Emily sunk into a deep mental depression and limited others to see her true identity by remaining hidden,  Ã¢â‚¬Å"When we next saw Miss Emily, she had grown fat and her hair was turning gray† (292). She lived most of her life in isolation and was intimidated by her controlling father. When Miss Emily was alive, the townspeople considered her as a financial obligation because she never paid taxes. She hadn’t paid in years, and she wasn’t forced to pay â€Å"See Colonel Sartoris, I have no taxes in Jefferson† (288). Her nonpayment dated back to 1894 when the mayor of the town, Mayor Colonel Sartoris, told the story that her father loaned the town money and as payment back to her father they allowed her not to pay taxes. Her father died and left Miss Emily with no money to live off of and the inheritance of a decaying house. As time passed and generations came and went, the arrangement became a discontent with the people so they made many attempts to collect the long time debt but as adamant as they were, so was Emily. She would not respond to their efforts. Finally after numerous failed notifications, the town’s board decided to make a trip to her house hoping to get an agreement to satisfy the debt. Emily hadn’t had visitors in years, but greeted by her old house servant, the board was permitted to enter into the damp stenched home and waited in the room until Miss Grierson was summoned. When Emily enters; small, round and dressed in black, not nearly as appealing as she was once described, the visitors affirmed their purpose. They requested compensation for her taxes, but Emily’s harsh and bold demanded that she didn’t have taxes and instructed Tobe, her house servant, to escort them out, â€Å"I have no taxes in Jefferson. Tobe!† The Negro appeared. â€Å"Show these gentlemen out.† (288). Emily always wanted a home where she can feel loved and free in, but it didn’t turn out that way as the complaints poured in from neighbors and townspeople about a smell lingering around the home and demanded the new mayor to take action. Judge Stevens, old in his years, didn’t know what he could do to fix the problem. He thought the smell might have been a dead rodent that the caretaker must have killed in the yard, â€Å"It’s probably just a snake or a rat that nigger of hers killed in the yard† (289). To quiet down the complaints, he said he would send the message to Ms. Emily’s servant. As more complaints came in and the problem persisted, a group of men decided to take matters into their own hands and made a visit to Miss Emily’s house, â€Å"They broke open the cellular door and sprinkled lime there, and in all the out buildings† (289). After some time, the smell went away. During her younger years, people felt bad for Miss Emily. Her great-aunt old lady Wyatt had gone mad and her father sheltered her so much that he didn’t allow her too far from his sight. He drove everyone away. He felt that there was no young man good enough for his Emily, so she never married and didn’t have any friends. The Griersons believed they were a higher class than most. Emily didn’t have a relationship with her family in Alabama because her father had a fallen out with them over Aunt Wyatt’s property. When Mr. Grierson died, Emily denied he was dead and left him in the house for three days. After many failed attempts by the townspeople to persuade her to get rid of his decomposing body, she let go and buried her father. Now she was all alone and didn’t come out much. Time passed and it was a long time before anyone had seen Emily, â€Å"When we saw her again, her hair was cut short, making her look like a girl with a vague resemblance to those angels in colored church windows† (290). Emily’s new look made her seem younger. After Emily’s father’s death, the town paid a construction company to pave the sidewalks. The foreman, Homer Barron, was from up north and grew to know the townspeople. He was â€Å"a big dark, ready men, with a big voice and eyes lighter than his face† (290). Homer was Emily’s secret lover, â€Å"Miss Emily and her lover Homer Barron, had been carrying on for the better part of two years† (Scherting398), whether that meant he was dead or alive. Rumors in the town said Homer would not get married, â€Å"Homer himself had remarked-he liked men, and it was known that he drank with the younger men in the Elks Club-that he was not a marrying man† (291). When Emily requested arsenic from the druggist, the town started to become curious whether she was going to kill herself or not, â€Å"I want some poison,† she said to the druggist† (290). Little did they know that it was for Homer, â€Å"Emily feels so disillusioned and desperate th at she manages to poison him, feeling that in this way she can keep him forever with her† (Yang 73). People often saw Homer and Emily together on Sunday afternoons driving in a buggy. Some of the town’s ladies weren’t too pleased with the sight. As Homer and Miss Emily spent more time together, the ladies thought it was a dishonor to the town and a terrible example to the young folks so they reached out to her family in Alabama to see if they can come and stay with her. During the cousins stay, Emily went to the store and bought jewelry, a toilet set,  men’s clothing and a nightshirt. They were thought to surely be married now with Emily preparing for his stay, but while the cousins were at the house, Homer left. Soon after her relatives left Homer returned. After his last sighting entering Miss Emily’s house, Homer was never seen again as well as Miss Emily, but from time to time she would be seen by her window. People thought Miss Grierson went crazy. It was years before she would be seen again, â€Å"When we next saw Miss Emily, she had grown fat an d her hair was turning gray† (292). Emily got ill and died downstairs in one of the rooms. The funeral was held days after Miss Emily’s death. Her family and the townspeople came to make their final view. Ladies all about, men in their confederate uniforms, on the porch and in the yard, they waited after Emily was buried before they went in the room that hadn’t been visited in decades. When the door was broken down, dust filled the room. Inside, it looked like a preparation for a wedding; decorated with faded rose color curtains and lights. Across the room stood a dressing table with crystal set in row and a man’s tarnished, silver toilet set. There also rest a collar and tie. Hanging on a chair, a suit cautiously folded and accompanied by some shoes and socks. To the spectators surprise, lying amongst everything rest Homer. Underneath his nightshirt, his body was molded to fit an embrace. Imprinted on a pillow next to his decayed remains; caressed by time, laid an indentation of a head. In the crest of the indentation rest a single long, gray strand o f hair from Miss Emily head. It was not until her final day of death that the readers could fully picture Emily as being insane. Having being denied male companionship by her father, she was desperate for love. She was so crazy that she killed the man she loved and used her aristocratic position to cover up the murder. By killing Homer, she didn’t realize that she was sentencing herself to total isolation, no contact with anything or anyone from the outside world. The narrator persuaded the reader to believe that Emily killed Homer and then preserved his body in the moment of her most anticipated day. To her, she sealed her love, preventing the stroke of loneliness. Always being comforted by his touch, she laid with him until she became ill and overcome by death. Work Cited SparkNotes Editors. â€Å"SparkNote on A Rose for Emily.† SparkNotes.com. SparkNotes LLC. 2007. Web. 14 Mar. 2013 Dliworth, Thomas. â€Å"A Romance to Kill For: Homocidal Complicity in Faulkner’s A Rose for Emily.† Studies in Short Fiction 361999 251-62. 21 Nov 2008. Yagcioglu, Semiramis. â€Å"Language, Subjectivity and Ideology in â€Å"A Rose for Emily†.† Journal of American Studies of Turkey 2(1995) 49-59. 21 Nov 2008. Faulkner, William. â€Å"A Rose for Emily.† In The Norton Anthology of American Literature. Ed. Nina Baym. 2160-2166. New York: W.W. Norton, 2003.

The Theme of Carpe Diem in Robert Herricks To the Virgins to Make Much

The Theme of Carpe Diem in Robert Herrick's To the Virgins to Make Much of Time Robert Herrick's poem, "To the Virgins to Make Much of Time," focuses on the idea of carpe diem. More specifically, in this poem the idea of marriage while love and flesh are still young should be heeded or one may suffer in their later years alone and loveless. Herrick suggests that this gift of virginity might be a great waste if not given while it is still desirable. Virginity is a gift for the simple reason that it can only be given once to the taker of the prize, which he believes should be the husband. Therefore, he says to go out and find husbands, for youth is not perpetual and will eventually succumb to old age and loneliness. Through Herrick's use of colorful imagery and personification, the reader detects a sense of urgency and duty for the virgins to go forth and marry while time is still at hand and love is bountiful, thus creating the overall idea of carpe diem. The first stanza of the poem opens to the personification of the flowers as the virgins: Gather ye Rose-buds while ye may, Old Time is still a flying: And this same flower that smiles today, To morrow will be dying. (ll. 1-4) The rosebuds correspond to the virgins in that they are beautiful and delicate, yet they have not reached their full potential and maturity by becoming full bloomed roses. Time is also personified as, "Old Time," which suggests a genial greybeard more than a grim reaper (Rollin 83). Time is still "a flying" suggests a comical image more than ominous but still one of urgency (Rollin 83). The image of the smiling flower indicates innocence and freshness but it only "smiles today, To morrow [it] will be dying." A grim and abrupt end comes to t... ...s across his idea of carpe diem in a very understandable way. The images used were easily comprehended, and the poem was often comical. His advice is very typical of a charismatic man who easily can manipulate words in his favor. One illustration that came across from this poem was one of entertainment, and not surprisingly mostly on the behalf of men. I can imagine the laughter this poem would draw from women in a bar if a man attempted to use these arguments as pick-up lines. Yet, the message does have a serious light in that time should not be taken for granted. Something that one may possess today, such as beauty or youthfulness, will eventually succumb to old age. Experience things while they are still fresh and untouched, for later on one may regret not having done so. Works Cited Rollin, Roger B. Robert Herrick. New York: Twayne Publishers, 1992. 83-84.

Pay for Performance Essay

Prior to the 2000s, fee-for-service systems dominated how health care providers received payment for providing care to patients. Under the fee-for-service system, physicians received payments, according to the volume of patients and the complexity of services. Two reports written by the Institute of Medicine clearly substantiated serious deficiencies in the quality of health care in the United States. The findings prompted the need to develop initiatives to pay health care workers based on quality. The following discussion defines pay-for-performance, explains the effects of reimbursement under this approach, details the impact of system cost reductions on the quality and efficiency of health care, the effects of this model on health care providers and customers, and the effect pay-for-performance will have on the future of health care. The Definition of Pay for Performance Pay for performance models reward providers, such as physicians, other health care providers, hospitals, and medical groups under contract for meeting pre-established performance measures to improve quality and efficiency in health care delivery. It is popular among policy makers and private and public payers, such as Medicare and Medicaid. The first initiative adopted by one of the nation’s largest health care plans, PacifiCare Health Systems, began paying medical groups in California bonuses for meeting or exceeding 10 clinical and service quality targets in 2003 (Meredith, Richard, Zhonghe, & Arnold, 2005). Service quality targets included five patient-reported measures of service quality, five ambulatory care quality indicators, and a set of hospital quality measures for referring patients to high-quality hospitals. The criteria in the first year required medical groups to acquire a minimum of 1000 PacifiCare Commercial and 100 Secure Horizons enrollees. Research showed the network of California medical groups, under contract to improve performance goals, outweighed the performance measure of another medical group not under contract, Pacific Northwest, for cervical cancer screening by a significance of 3.6%. Of 163 eligible physician groups, 97 (60%) received a distribution of funds from the program related to at least 1 physician group quality performance target in the first quarter of the QIP. In the last payout based on the original set of targets (April 2004), 129 of 172 (75%) groups reached at least 1 physician group quality target. (Meredith, Richard, Zhonghe, & Arnold, 2005, para. 26) Only 14 medical groups exceeded more than half of the performance targets. The pay-for-performance approach showed an inverse relationship where physician groups with lower performance improved the most whereas physician groups that previously achieved target goals improved the least. The Effects of Reimbursement under Pay for Performance The article Early Experience With Pay-For-Performance: From Concept to Practice (Meredith, Richards, Zhonghe, & Arnold, 2005) argues this approach to improving the quality of care fulfills multiple objectives. One positive impact of pay-for-performance suggests paying health care providers for meeting certain quality indicators increases performance. The authors claim low-performing health care providers improved because they viewed the landscape of health care delivery changing by the mounting pressure of payees to improve their health care systems and decided to remain in good standing. Low-performing health care providers contend they cannot achieve benchmark levels of performance because of barriers beyond their control, such as limited resources or low-socioeconomic, patient populations. A negative impact of pay-for-performance indicates high-performing health care providers meeting target levels have no incentive to improve their performance and thus offer status quo health care services to their patients. Another reason health care providers have no incentive to produce services beyond the norm indicates low rewards paid by insurance networks. â€Å"Paying for improvement fails to reward and even penalizes providers that have already achieved high levels of health care quality at the time a pay-for-performance program is initiated† (Meredith, Richards, Zhonghe, & Arnold, 2005, para. 32). For the reasons stated above, the distribution of rewards primarily goes to the group of providers with low-performing standards and increases the impact of pay-for-performance. Impact of System Cost Reductions on Quality and Efficiency of Health Care Evidence of pay-for-performance shows mixed results. One study, Premier Hospital Quality Incentive Demonstration, performed by Rachel M. Werner of the University of Pennsylvania, compared the improvements in quality for hospitals paid incentives to a control group of hospitals who did not receive incentives from 2004 – 2008. The results reflected minor significance in improvement in the quality and efficiency of health care. In fact, diminishing returns occurred after the fifth year (Health Policy Brief, 2012)(See Figure 1). Other pay-for-performance initiatives, such as the Medicare Premier Hospital Quality Incentive, rolled out at the same time as Werner’s study, which analysts profess as the reason behind the improvement in quality and efficiency of health care among hospitals. Like health care providers, hospitals did not want to endure the embarrassment of presenting an image lacking in quality care. They sought to clean up their acts in anticipation of the Centers for Medicare and Medicaid Services (CMS) implementing pay-for-performance measures in health care. A project conducted between 2005 and 2010, the Medicare Physician Group Practice Demonstration, focused on quality and cost. Researchers of Dartmouth College and the National Bureau for Economic Research analyzed doctors, who would receive bonuses for achieving lower cost growth and meeting quality targets, in 10 large physician group practices. They found improvement in the quality of care but little reduction in the growth of spending for most Medicare patients (Health Policy Brief, 2012). Effects on Health Care Providers and Customers Health care providers agree with the need to improve quality of care but have concerns with pay-for performance. It takes money to implement, maintain, and document quality measures. They reason if payees give modest payments as incentives, they cannot recoup additional administrative costs and provide quality care simultaneously. Others fear the implementation of health information technology for data collection and reporting will close the doors of their practices. The American Medical Association (AMA) believes providers should have the choice to volunteer in incentive programs, review, comment, and appeal performance data, and receive payment for participating (Health Policy Brief, 2012). Another issue health care providers have with this cost containment model lies on the premise that hospitals that care for patients from low-income backgrounds bear the burden of lower improvement scores compared to hospitals that care for patients from mid-level to high-level incomes. Lower improvement scores result from low-income patients’ lack of transportation, language barriers, and childcare among other barriers to access health care services. Limited access to care halts the prevention and treatment of chronic illnesses and increases readmission rates of patients to hospitals. As a result, hospitals incur penalties. Health care providers concerned with the impact these arrangements have on patients, oppose these programs because they think patient care will weaken at the expense of cost containment. Physicians have the power to control their pay by hand-picking the best patients to maintain or increase their performance measures. By selecting healthier patients, physicians widen the gap for racial and ethnic disparities in health care delivery. A study by Jha and colleagues of costs and quality in US hospitals found a group that consistently performed worse on both quality and cost metrics and that cares for proportionally greater numbers of elderly black and Medicaid patients than other institutions. (Health Policy Brief, 2012, para. 42) In comparison, a Yale study showed safety-net hospitals outperformed hospitals that treated less proportionate numbers of low-income patients. Effects on the Future of Health Care The implementation of the Affordable Care Act (ACA) will increase the need for pay-for-performance programs and incentives. The Affordable Care Act promises to increase the enrollment of Medicaid and Medicare patients. Health care workers will find challenges with a large generation of Baby Boomers who will need long-term care. Under the ACA health care providers’ scores will include indicators, which measure patient-centered care, family engagement, and the ability to address disparities in health care delivery. As well, under the ‘Value-Based Purchasing Incentive’ mandates of the ACA, the Centers for Medicare [and] Medicaid Services have not only proposed additional process-of-care quality and mortality outcome measures on which to base future payments but also an integration of patient experience scores, representing up to 30% of hospital incentive payments, financially penalizing those with low scores. (Liang & Mackey, 2011, p. 1427) Not only that but also hospitals will have to report efficiency measures to include Medicare spending per beneficiary. Mandates will not only require quality but also focus on reducing costs. New programs will measure the reduction of costly hospital readmissions, restrict Medicaid payments for hospital-acquired conditions, and reduce Medicare payments to hospitals with the highest rates of medical harm. Conclusion Reports and studies support evidence, which shows pay-for-performance does not improve the quality of care nor reduce the costs of health care. Researchers must find ways to improve quality of care over a substantial period, close racial and economic disparity gaps, and increase health care worker acceptance of pay-for-performance programs, and incentives, which motivate providers to produce more positive health outcomes. Developers of program incentives should use tools, which help monitor and evaluate health care outcomes aside from other factors with variations in health care markets. By collecting data, researchers can design programs that improve quality of care and reduce costs. References Health Policy Brief: Pay-for-Performance. (2012, October 11). Health Affairs. Retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78 Liang, B. A., & Mackey, T. (2011). Quality and Safety in Medical Care: What Does the Future Hold?. Archives Of Pathology & Laboratory Medicine, 135(11), 1425-1431. doi:10.5858/arpa.2011-0154-OA Meredith, B. R., PhD, Richard, G. F., PhD, Zhonghe, L., MA, & Arnold, M. E., MD, MA. (2005). Early experience with pay-for-performance: From concept to practice. The Journal of the American Medical Association, 294(14), 1788–1793. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=201673 Shaman, H. (2008). What you need to know about pay for performance. Hfm (Healthcare Financial Management), 62(10), 92-96.