The Happy Family Lives Of Canada Essay - 1654 Words

While gay and lesbian people are as diverse as everyone else, their shared experience of discrimination seems to unite them. The blog I have chosen to focus on for this analysis is a married lesbian couple with two children. Jen and Allison are two lesbians who had their first child in January 2011 and had their second child in December 2012. The happy family lives in Canada. Canada is internationally seen as the leader in the development of equality regarding to the lesbian, gay, bisexual, transgender, and plus community compared to any other country including the United States of America. In July 20, 2005, Canada became one of the countries in the world to allow same sex marriage while in the Unites States a federal law passed on June 26, 2015 that allowed same sex marriage across the States (Rau, 2015). Jen and Allison have always have a strong support system from the moment they both decided to come out, but that does not mean they have not faced discrimination. The couple decid ed to settle in Canada due to America being more conservative. Blog Abstract Jen was born and raised near Pittsburgh, Pennsylvania. While Allison, was born and raised in Toronto, Canada. They met for the first time at a concert in London, Ontario, Canada. From that moment on, a romance was born. The started doing long-distance dating in 2001. The couple would take turns traveling to see each other. Jen would drive six hours to see Allison, and Allison would make a twelve hour trip by theShow MoreRelatedMammitas Garden Cove Essay984 Words   |  4 PagesCyril Dabydeen, the author uses the literary techniques questions, tone, and flashbacks to convey the main characters view on place. Max believes that he will have better opportunities in Canada rather than in his home country. This short story details his views on his life at this point, and how he is doing in Canada. The prompt immediately begins with the question, â€Å"Where d’you come from?†. This tells the reader that Max is not from the current country or setting in which the story takes place. ThroughoutRead MoreWhy Polygamy Should Remain Illegal1328 Words   |  6 Pagesup to 5 years in prison but prosecutions are rare. Despite the religious beliefs, polygamy should remain illegal and should be enforced strictly. Polygamy brings on various legal complications and greatly damages children and women in polygamous families. Women play a major role in polygamous communities; from raising the children, to being the epicentres of the polygamous marriages. Polygamy should remain illegal to help save women from these abusive relationships, jealousy and getting marriedRead MoreGlobal Health Issue Project : Canada Essay1562 Words   |  7 PagesGlobal Health Issue Project: Canada Canada is the second largest country by total area in the world, extending from the Pacific to the Atlantic Ocean and north into the Arctic Ocean. Canada has ten Provinces and three Territories, bordering the United States on the South and Northwest sides. Ottawa is Canada capital city located in Ontario. Canada became its own country July 1, 1867 with the creation of the Constitution Act. Currently, Canada is home to a little over 36 million people, ranking asRead MoreEssay about McDonald’s Contribution to the Environment and the Community1726 Words   |  7 Pagesthis restaurants name? There are different food choices, career opportunities and community commitments within this corporation. Some may think McDonald’s is the greatest food service retailer or perhaps the worst company that could have evolved in Canada and the United States. The content entailed in this report shall inform you that there are more then just hamburgers and french fries in the world of McDonald’s. The major topics covered are McDonald’s contribution to the environment, and to theRead MoreBeing A Second Generation American Woman956 Words   |  4 Pagesfelt I was being brought up by my mother to be a â€Å"happy homemaker.† When I was finally able to date, I was 18 in college. I never keep secrets from my parents, so when it was time for the â€Å"sex talk† it was interesting. My health insurance is under my father’s name so I felt obligated to tell them that I was planning on going on birth control. I didn’t want them finding out that I was sexually active through the Kaiser bill. My mother was not happy. She had never used birth control in her life. FranklyRead MorePolygamy in Canada Essay1059 Words   |  5 PagesWithin Canada we have a generous amount of freedom but this leads to the abuse of o ur system. This is especially true with regards to polygamy in Bountiful, BC. Because women are susceptible to mental abuse in polygamist relationships it should continue to be illegal in Canada. If this law is in enforced it would help women to be freed of the oppression caused by male domination, eliminate the need for women to suppress feelings that conflict with the ideals of the polygamy life, and aid in avoidingRead MoreHofstede s Six Dimensions Of Culture1119 Words   |  5 Pageschildren are taught obedience by their parents. Canada has a score of 39 and Ukraine – 92. Canadian culture is leaning towards equality, which means people establish hierarchy for convenience; money is distributed more even in society and superiors/managers depend on employees. By contrast, Ukrainian culture has a high score: often corruption, uneven money distribution, revolutions needed to replace government. When it comes to subordination, in Canada people are expecting to be consulted, in UkraineRead MoreDouble Entry Journal Example1193 Words   |  5 Pagesâ€Å"Moushumi wonders how long she will live her life in trappings of student hood in spite of the fact that she is a married woman that she’s as far along in her studies as she is that Nikhil has a respectable if not terribly lucrative job. It would have been different with Graham-he’d made more than enough for both of them† (Lahiri 254) | One of the main themes in this story is pressure. Throughout the story Gogol feels pressured by his parents to follow the Bengali culture, to marry a Bengali girlRead MoreWhy I Live At The P.o.777 Words   |  3 PagesChina Grove In Eudora Welty s story, ?Why do I Live At The P.O., the main character directs the focus of the reader through her own point of view. The story is set in a small Mississippi town, sometime after World War II. The time and the place have a significant effect upon the language used. This helps to create an overall mood that is d ominated by Southern prejudices, interpersonal ignorance and simplicity; for example, Sister says ?Nigger girl? (1031) words that now demonstrate racism but atRead MoreFamilies Should Be Planned Essay913 Words   |  4 Pages Every family differ from each other, each family has its own unique ideas, rules, and beliefs. Families are important because they are the very first people that anyone would interact with and they would adapt any attitude from their family.Every person tends to have the same ideas and beliefs as their family does and people generally follow the same paths as their family does. Parents are the base and the foundation of their family and the house. Both mother and father play the biggest role

Essay about Critique of the Communist Manifesto - 861 Words

Assignment No. 3: Critique of the Communist Manifesto Karl Marx and Freidrich Engels Communist Manifesto is one of the worlds most influential pieces of political literature. The manifesto was created for the purpose of outlining the aims and goals of the The Communist League. The Communist League was made up of radical proletariats who were fed up with the bourgeoisie social order and sought to overthrow them. The manifesto is known to have been written by Marx and assisted and edited by Engel therefore the many ideas and theories expressed by this work are known as Marxism. Marxism has many poignant views on changing society and its class structure, and what needs to be done to achieve these changes. The Marxism theories do fall†¦show more content†¦The manifesto continues with Marxs belief that capitalism is very unsteady and that this class struggle between the bourgeoisie and proletariat is inevitable under this system. But Marx explains that the only means for communism to spread in a society ruled by capitalism and clas s distinctions is by revolution. A problem with Marxism is that this whole concept reflects on creating an imaginary future which is filled with all the answers to the problems of the workers in modern society. The only way people will be able to reach this future is by forfeiting all their personal hopes and dreams for the sake of the proletariat class. Marx undermines the fact that all people do not share the same desires, and that his idea of upheaval of the bourgeoisie might not entice the public as a whole. Especially since Marxism revolutions will meet a violent event in time, where the bourgeoisie and proletariat will clash. This conflict is not the most convincing means for change (for individuals who seek a peaceful way of living). As well Marx never gives a good description for how the proletariat should govern the state once they take power. John Locke proposes in the Second Treatise on Government that The earth, and all that is therein, is given to men for the support an d comfort of their being. Which raises the question how could someone differentiate common propertyShow MoreRelatedMarxist Critique Of The Communist Manifesto, Marx And Engels2021 Words   |  9 PagesMill’s Liberal Response to Marx’s Communist Critique of Capitalism Yujun Huang In The Communist Manifesto, Marx and Engels present the flaws of the modern capitalistic society by pointing out its unfair ruling class, the phenomenon of alienation, and excessive individuality in order to emphasize the aim of Communism of eliminating economic gaps between the social classes. According to On Liberty, Mill would respond to Marx by agreeing with Marx’s fundamental ideals and disagree with his socialistRead MoreMarx, Mill And Freud s Critique Of Political Economy And The Communist Manifesto Essay1133 Words   |  5 Pagestackle the topic of freedom in unique ways, but their messages are fundamentally the same and continue the ideas that we encountered in the esoteric texts as well as in The Matrix: . First, we have Karl Marx’s Capital: Critique of Political Economy and The Communist Manifesto, where we encounter the proletariat, or the working-class people regarded collectively. In these two texts, the latter of which was co-authored by Frederick Engels, we learn that the proletariat is enslaved just like the peopleRead MoreCommunism Created By Karl Marx And Friedrich Engels799 Words   |  4 Pagesthis is when his interest and critique of religion and government began. When he went to university he joined the Young Hegelian movement, and he produced a radical critique of Christianity (Kreis, 2000). After the critique in the Young Hegelian movement he became an editor for Rheinische Zeitung powerful liberal newspaper. After some controversial articles by Marx the Prussian government shut it down. He then went to France. During his time in France he became a communist and set down his views inRead MoreCommunist Manifesto, And Estranged Labor1173 Words   |  5 Pagesalwa ys put down. When I think of a communist society I envision North Korea. A society that most people do not know much about other than the fact that people have zero rights, everything is monitored, only propaganda is released, and it is overall a horrible way of life. The first time my eyes were open up to the idea that communism may not be all that bad was reading Marx’s â€Å"Communist Manifesto† and â€Å"Estranged Labor.† Marx successfully challenged the critiques put forward on such a controversialRead MoreMarx And Engels s Critique And Critique Of Capitalism1669 Words   |  7 PagesThe specialised critique of capitalism found in the Communist Manifesto (written by Karl Marx and Fredrick Engels), provides a basis for the analysis and critique of the capitalist system. Marx and Engels wrote about economical in relation to the means or mode of production, ideology, alienation and most fundamentally, class relations (particularly between the bourgeoisie and the proletariat). Collectively, these two men created the theory of Marxism. There are multiple critiques of Marxism thatRead MoreConflict Theory, Karl Marx, and the Communist Manifesto Essay1321 Words   |  6 PagesConflict Theory, Karl Marx, and The Communist Manifesto In order to understand Marx a few terms need to be defined. The first is Bourgeoisie; these are the Capitalists and they are the employers of wage laborers, and the owners of the means of production. The means of production includes the physical instruments of production such as the machines, and tools, as well as the methods of working (skills, division of labor). The Proletariat is the class of wage-laborers, they do not have their ownRead MoreKarl Marx And The Communist Manifesto1453 Words   |  6 PagesIn the Communist Manifesto, a document that first proclaimed the ideology of communism itself, Marx declared that the â€Å"history of all hitherto existing society is the history of class struggles† (Marx, Karl and Frederick Engels). As a man who spurred resentment of governments and inspired revolutionaries, Karl Marx is often regarded as a man who led to the rise of 20th century tyrannical dictators such as Stalin and Mao to take power. His ideas are regarded as fai lures and, by some, are seen asRead MoreThe Communist Manifesto By Karl Marx And Friedrich Engels1255 Words   |  6 PagesThe Communist Manifesto was written by Karl Marx and Friedrich Engels to begin explaining Communism and its goals. The Manifesto suggests that history acts according to what is called â€Å"class struggle.† The â€Å"means of production† are what truly defines the class relationships according to Marx and Engels (Marx 2002). Inevitably, the classes conflict and become hostile, no longer moving fluidly (Spalding 2000). The Manifesto states that this conflict becomes so severe that it eventually becomes a revolutionRead MoreThe Marxist Model Of Class Struggles1052 Words   |  5 PagesThe Marxist Model is thoroughly used throughout the duration of The Communist Manifesto to break down the complexity of the pamphlet into 3 parts. The 3 parts include history, economics, and social class; each collaboratively explaining the alienation of certain socia l classes and how class struggles arise. Karl Marx presents the notion that history is inevitable and the idea of class struggles will always be present in society. Marx recounts the numerous times in society where social classes crashedRead MoreKarl Marx And Friedrich Engels1224 Words   |  5 PagesKarl Marx and Friedrich Engels were asked to write a manifesto for a group that they had recently been accepted into, a group known as the â€Å"Communist League,† a group of activists that met in London. Marx and Engels – though Engels primarily took care of editing and revising, Marx did a large amount of the writing – would write The Communist Manifesto for this group. After the manifesto was published, it became one of the most well-known as well as influential pieces of philosophy, and is the reason

What Influences Free Clinic Usage by the Uninsured Free Essays

string(73) " eliminating the need for hospitalization \(Corso Fertig, 2011\)\." What Influences Free Clinic Usage by the Uninsured? By Shelli Thomason A Paper Submitted to Dr. Dayna McDaniel Research Methods PA6601 Term 5, 2012 Troy University July 27, 2012 TABLE OF CONTENTS CHAPTER 1 Introduction †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. We will write a custom essay sample on What Influences Free Clinic Usage by the Uninsured or any similar topic only for you Order Now 4 Statement of the Problem†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 2. 1 Purpose †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 6 2. 2 Problem Statement†¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 6 2. 3 Research Questions†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 2. 4 Scope†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1. Literature Review†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 Dependent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 9 1st Independent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11 2nd Independent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 13 3rd Independent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 14 4th Independent variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 16 4Hypothesis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18 4. 1 H1: hypothesis one†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18 4. 2 H2: hypothesis two†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18 4. 3 H3: hypothesis three†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦18 4. H4: hypothesis four†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 18 Chapter II: Methodology Design†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦ 18 Population/Sample†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 20 Variables†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦21 Dependent Variable†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 21 Independent Variables†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦22 Data Collection†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦22 Measuring Instrument†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦. 22 Materials†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 23 Delivery Method†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 24 Data Analysis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦ 24 Chapter III: Anticipated Findings†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 25 Chapter IV: Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦25 Implications†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦26 Recommendations†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦26 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦28 – 30 Appendices Appendix A Schematic Model†¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦.. 31 Appendix B Formula for Calculating Population Sample Size†¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 32 Appendix C Survey†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. †¦Ã¢â‚¬ ¦ †¦ 33 – 35 Appendix D Demographics†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦36 Appendix E Example of Multiple Regression results†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦37 Chapter 1 Introduction Many United States residents delay or do without necessary healthcare because they lack the resources or knowledge to access it. There are 46 million people in the nation who have no health care coverage, and by not giving necessary attention to medical concerns and conditions, poor health risks increase, along with untimely mortality (Darnell, 2010). A Kaiser Commission study from 2006 identifies there are 18,000 deaths yearly in the United States resulting from lack of health care coverage (Trask, 2011). Recent Census Bureau shows a slightly higher number of uninsured indicating there are 50 million uninsured, which would be the largest number on record, resulting from the national economic recession (Krisberg, 2010). According to Darnell (2010), there are 1007 free clinics in the nation, providing services during 3. 5 million clinic visits, by 1. 8 million uninsured patients, representing approximately 10% of uninsured adults of working age. The patients have no other health care alternatives to a free clinic due to a variety of factors including: no ability to pay, language barriers, lack of or inadequate medical insurance, homelessness, inaccessibility, and immigration or ethnicity issues. As private non-profit organizations, free-clinics are not recipients of federal funding, so many rely on state funding, local funding, and donations. Depaul (2010) notes that the National Association of Free Clinics estimated four million patients were seen in 2008, which doubled in 2009. It is also noted that free clinics have to turn away patients because they cannot meet the demands. In a white paper for the American College of Physicians, Gorman (2004) notes, those who do not receive annual exams and preventative screenings run the risk of a delayed diagnosis and subsequent treatment, resulting in premature mortality. Additionally, untreated chronic symptoms result in worsened conditions and costly emergency care, placing a financial burden on hospitals, families and ultimately on the community. Furthermore, workers who experience poor health have lower productivity which is costly to the economy. Therefore, free clinics are a crucial component in the consortium of health care options in the United States. Isaacs and Jellinek (2007), state that 80 % of patients who receive primary care at a physician’s office are either uninsured or have Medicaid. Although physicians may see uninsured patients in their offices and take on a few of them as charitable cases, this practice is declining given lower insurance and Medicaid reimbursements and increased operational expenses. The nation has what is referred to as a safety net system to provide health care services for residents who are uninsured. This system is comprised of hospital emergency rooms, publicly funded health centers, and free clinics. With costs of health care escalating, it is crucial to identify methods to effectively optimize these providers. It has been suggested that accessibility to free clinics, which may keep the uninsured from accessing the ER for non-emergent care, is one such method. Studies show uninsured persons utilizing a free clinic have fewer emergency room visits than those who do frequent the ER for their primary care, which renders cost savings (Trask, 2011). Statement of the Problem Purpose The purpose in this research is to make determinations as to what factors influence an uninsured person’s decision to access the services of a free clinic. In an effort to answer this question, factors will be recognized, through research, significant to a person making the decision to visit a free clinic for medical care. Uncovering these factors could assist in discouraging the misuse of other types of medical safety net provisions. One study shows if the group studied did not have use of a free clinic, 80% of the visits would have resulted in ER visits for non-emergency treatments (Corso Fertig, 2011). This information could also assist in identifying strategies to effectively address the health care needs of constituents and provide funding sources with knowledge to make educated decisions on the most effective use of funds. Problem Statement This project will pinpoint the most acute variables influencing an uninsured person to seek treatment at a free health clinic, allowing local government leaders and medical providers to have access to research so they may further understand areas in which to place their focus and funding. Furthermore, an ancillary reason for study is to show that by providing an uninsured person who is truly ill with a way to achieve wellness, they can become viable again, thus becoming a more productive worker, who may regain insurance and no longer need the free service, or any other type of medical care. If a person has a resource within which to address health concerns, that does not present them with barriers, they are likely to receive the necessary care needed, reducing further complications and costs, placing them in a position to become more sustainable. In one Healthcare Georgia study, evidence shows that free clinics can halt the escalation of health problems, reducing or eliminating the need for hospitalization (Corso Fertig, 2011). You read "What Influences Free Clinic Usage by the Uninsured" in category "Essay examples" Research questions This project will focus on four research questions that will aide in identifying specific factors that influence an uninsured person to use a free clinic (dependent variable). The primary question to be asked is â€Å"What factors influence an uninsured person to use a free clinic? Research questions inquiring about those influences (independent variables) are: 1) Does lack of alternative health care options influence an uninsured person to use a free clinic? 2) Does housing status influence an uninsured person to use a free clinic? 3) Does Hispanic ethnicity influence an uninsured person to use a free clinic? 4) Does age influence an uninsured person to use a free clinic? The independent var iables thought to influence the dependent variable are defined so there is a clear understanding of their meaning. Lack of other alternatives: Many users of free clinics may have no other options for health care than a free clinic. They may be employed, but cannot afford the health care premiums offered by their employer or the employer does not offer health coverage. 83 percent of the patients seen at free clinics come from a working household and may hold two or three part time jobs (DePaul, 2010). Federally funded community health centers, different from free clinics, are typically located in rural or inner-city areas and help serve a large number of patients in high-needs communities. In 2009, the Government Accountability Office indicated that even with 8000 community health centers, there were still 43 percent of underserved areas without access (Whelan, 2010). Housing Status: The definition of â€Å"homeless† is a broader scope than merely the population living on the streets and includes individuals in a widespread range of unstable housing scenarios. Homeless individuals do not only live under bridges or in a car, but may also reside in emergency shelters; foster homes; HUD’s terminology of â€Å"doubling up† with relatives or friends; or tenants who have been served an eviction notice. Unstable housing status is a high risk factor for health disparities, much like genetics or eating habits. On average, a homeless person has eight to nine coexisting health problems (Batra et al. , 2009). A study of 6,308 homeless Philadelphians determined the mortality rate among the homeless was 3. 5 times that of the city’s overall population. Earlier research has also noted the homeless have escalated rates of a vast array of health problems (Lewis, Andersen and Gelberg, 2003). Age: Different clinics have differing eligibility for the patients they serve. Many states have the option to offer an insurance plan covering children through the passage of the Children’s Health Insurance Program Reauthorization Act (Llano, 2011), then those over age 65 have Medicare. Therefore many clinics tend to turn their efforts toward those uninsured patients between the ages of 18-64. A 2004 study shows that overall general health significantly declines for those between age 50 and 60 if they are uninsured, underinsured or sporadically insured, compared to their counterparts who have adequate health coverage (Inguanzo and Kaplan, 2011). Hispanic Ethnicity: Llano (2011) states the greatest hindrance to health care for Hispanics is the language barrier. Providers of service have difficulty communicating with Spanish speaking patients if there is no interpreter available, which may cause compromised diagnoses, treatment options and specialty referrals. Census Bureau data reveals that in 2010, 38. 7 percent of uninsured American residents were Hispanic (Inguanzo Kaplan, 2011). Scope A survey will be completed, as part of this research. This project’s scope will investigate what influences an uninsured person’s visit to a free clinic. It will assist the free clinic administration in further developing strategic plans to make determinations on where their efforts should be focused. It may also contribute to local governments and other potential grantor’s decisions on making allocations. Free clinic usage is the primary focus, although the collective information may show related trends and concerns constructive to area healthcare providers and local governments. Each person surveyed will be treated equally. This study’s sample population will include patients of two free clinics: Community of Hope Health Clinic and Cahaba Valley Health Care Clinic in Shelby County, Alabama. The clinic only sees uninsured patients on Mondays from 8:30 am to 4:30 pm and Thursdays from 5:30 pm to 8:30 pm. They must show proof of residency in Shelby County. Literature Review Dependent variable: Free clinic usage by the uninsured As stated earlier, experts concur that there are over 1000 free clinics in the nation, providing services during 3. 5 million clinic visits, by approximately 10% of uninsured adults of working age (Darnell, 2010; Gertz, Frank and Blixen, 2010; George Washington University Report to Congress, 2012). This equates to approximately 90% of uninsured adults who are not utilizing a free clinic for their medical needs. Gertz, Frank and Blixen (2010) go further to say that since 1980, when there were 30 million uninsured people, there has been a 50% increase to 45 million. From a statewide perspective, Rhode Island remains consistent with national levels, as uninsured working age adults under age 64 doubled between 2000 and 2005, citing the waning of employer health care coverage (Gerber, et al. , 2008). The yearly cost associated with uncompensated medical treatment for the uninsured in the nation was $56 million in 2008. Determinations were made to suggest that use of emergency rooms for non-emergent care, along with rising hospitalization which could have been prevented are on the rise and creating costly problems. Communities are seeking other solutions to provide health care to the uninsured, which might include free clinics, mobile clinics, and church and school sites to administer treatment (Fertig, A. , Corso, P. Balasubramaniam, D. , 2011). As stated earlier, free clinics are an important part of the United States health safety net, serving mainly the uninsured, working poor. Historically, given minimal resources and relying on volunteer health care providers, free clinics have focused on gap filling, temporary solutions to the population’s health problems. Implementing a new paradigm, free clinics are now making disease prevention and health promotion a top priority (Scariarti Williams, 2007). A nationwide cross-sectional study using a survey was conducted by Gertz, Frank and Blixen (2010) which they compared to the only other known published study of its kind by Nadkarni, et. al from 2005 to determine free clinic characteristics. Both studies revealed a mean of between 4,000 and 6,000 uninsured visits to the free clinics annually, and a third study agrees that most (67%) are located in the Southern region of the United States (Gertz, Frank Blixen, 2010; George Washington University Report to Congress, 2012). Additionally, 77% of the respondents of the Gertz, Frank and Blixen study (2010) indicated the level of care received at free clinics was superior to prior medical care received, and 24% indicated if there was no free clinic available, they would not seek care, mainly due to cost. A high number of free clinics seem to function as a fixed source of medical care for their patients. The majority of free clinics describe the service they provide to their patients as continuing, 20 percent indicate the care as recurrent, and 5 percent depicted the care as irregular, only seeing a patient once (George Washington University Report to Congress, 2012). In contrast, prior to the recent national economic recession, a study associated with the utilization of three Massachusetts free clinics was conducted to determine what factors influenced people to use the free clinics, when it appeared there were a variety of ample options for medical care irrespective of health care coverage or income level. Although the study unveiled the three free clinics saw patients who had insurance, 81% of the respondents were uninsured (Keis, DeGeus, Cashman Savageau, 2004). Lack of health care coverage, is the sixth-leading cause of death, equating to 18,000 deaths annually for adults between the ages of 25 and 64 (Groman, 2004). The uninsured person may encounter severe financial and wellness obstacles, limiting their ability to obtain medical care and many times become indebted and more ill, as a result. A study conducted by Becker (2001) found that not only did uninsured persons with chronic health conditions lack adequate health care; their illnesses were also inadequately managed. Other findings were that with deficiencies of education regarding their health, those persons who are uninsured lacked the information, understanding, and resources that would allow them to manage their illnesses more effectively. Many uninsured patients can pay more than double the cost if they are forced to use a hospital for their care, due to the inability for price leveraging that medical insurance providers can afford (Groman, 2004). 1st independent variable: Lack of other options The National Association of Free Clinics indicates they see patients they never thought would come to a free clinic, with 83% of free clinic patients come from working home, but cannot afford COBRA if they have lost a job and are now working several part time jobs. Patients have reported they would likely go the ER or not seek care if they did not have access to a free clinic (Depaul, 2010). Private practice doctors are the primary source of health care for the uninsured, mainly because, historically, they have been plentiful in numbers, with 720,000 providing care according to Isaacs Jellinek (2007). A second expert (Groman, R. 2004), agrees that free care by physicians is decreasing, which will greatly impact the medical safety net with growing numbers of uninsured. As stated earlier, the decline is largely the result of higher operating costs and inadequate Medicare reimbursement rates, prohibiting the doctors from being able to treat those who cannot pay (Isaacs Jellinek, 2007). Even though charity from practicing physicians plays a vital role in treating the uninsured, they are not stand-ins for health insurance. Because of revisions to financing and rganization of medical care systems, doctors indicate in a New York Academy of Medicine study, they are unable to provide the same class of care to the uninsured, as they provide to patients who have health care coverage (Groman, R. , 2004). A recent report to Congress indicates that free clinics overall see millions of uninsured persons who may not achieve any level of care elsewhere. One study highlighted in the report reveale d four main reason listed in order of percentage, people use a free clinic are: no health insurance (82%), referrals by others (59%), medications (38%), and no knowledge of where else to go (34%). The report also states that three quarters of free clinic patients do not have a regular method of care except the free clinic or the ER, suggesting free clinics fill voids, offering services not available (or easily reached) somewhere else (George Washington University Report to Congress, 2012). The Keis, et al. (2004) study is in accord with the report to Congress in that one-third of survey respondent gave their reason for using a free clinic as not knowing where else to go to receive medical attention. Another one-third cited lack of transportation, long wait times, finding child care or inability to leave work as the primary reasons they could not use other types of medical providers and instead sought treatment at a free clinic. As already learned, access to local safety net providers has limits to readiness in other ways as well. For example, in Jeffrey Trask’s unpublished dissertation (2011), he cites and agrees with the Keis study stating that other than the emergency room, many safety net providers aren’t open in the evenings or are scarce, so due to the need to work, a patient’s only option may be a free clinic open in the evenings. Likewise, clients of free clinics forego after care or specialty care only a hospital can offer due to costs. Trask (2011) gives the example, when an uninsured person using a free clinic needs additional services outside the free clinic’s scope of care, sometimes old or bad debt is a major obstacle to receiving necessary treatment. Finally, options are limited for people who are not legally residing in the country. A collective characteristic of a free clinic is capacity to treat any patient without documentation regarding immigration status (Keis 2004). In a 2010 national survey, a census, the first of its kind in 40 years, 764 clinics were deemed eligible out of 1188 surveys mailed. A finding from the study uncovered that free clinics are a more important aspect of the national safety net, especially in the area of ambulatory care that originally thought. However, only 188 of the clinics surveyed offered all-inclusive services, and the survey concluded that a free clinic is not a replacement for comprehensive primary care (Darnell, 2010). 2nd independent variable: Hispanic ethnicity Hispanic persons comprise approximately 16 percent of the population in the U. S. but make up 25 percent of free clinic patients. Experts agree that unbalanced degree of Hispanic patients in free clinics indicates higher rates of lack of health care coverage among this group (George Washington University Report to Congress, 2012; Isaacs Jellinek, 2007), with the latter authors citing an example from a Racine, Wisconsin clinic who had a one percent Hispanic patient base in late 1980s and a 50 percent Hispanic patients in 2006. Results were compared from two student-run free clinic studies on clinic characteristics and concurred that most of the patients were minorities. One study of 59 clinics reported that 31% of the patients seen were Hispanic, while the other study of 39 clinics revealed 53% of patients were Hispanic. The student run clinics demographic is quite different from non-student run clinic who report a client base of mainly non-Hispanic people (Gertz, Frank Blixen, 2010). Studies indicate that Hispanic persons are more likely than non-Hispanics to fail to complete the Medicaid application and miss important dates for submitting required documentation. Furthermore, 43 percent of Hispanics who speak Spanish had communication problems with physicians compared to 16 percent of Caucasians; and non-English speakers had more difficulty in comprehending doctor orders (Llano, 2011). Because of non-existent health insurance and consequently no immunizations, a considerable outbreak of rubella plagued a Hispanic community in New York in the late 90s. The outbreak spread to adjacent communities and those with insurance were just as affected. In communities with high numbers of uninsured residents, it becomes more ifficult to provide disease control, and medical personnel have fewer opportunities to identify early onset of outbreaks, hampering containment efforts (Groman, 2004). In a report examining the unmet medical needs of the nation’s Latino population conducted by the American College of Physicians and the American Society of Internal Medicine, it was discovered that uninsured women had twice the likelihood as their non-Latino pee rs to be diagnosed with breast cancer in the later stages and uninsured Latino men were four times as likely to receive a prostate cancer diagnosis compared to non-Latino men. It is suggested that Hispanic and Latino immigrants are very unlikely to have the ability to access health care services due to governmental restrictions of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, and fear that their citizenship opportunities will be compromised by attempting to secure public aid assistance (Inguanzo and Kaplan, 2011). 3rd independent variable: Homelessness According to Wilson (2009), there are close to 800,000 homeless people in the nation, many of which have multiple disorders to include asthma, nutritional deficiencies, skin infections, wounds, and diabetes, to name a few. Wilson’s and O’Connell’s research goes on to say that the homeless person’s ailments which are largely left untreated and worsen, lead to devastating illness. The mortality rate is excessively high in the homeless populace. O’Connell (2005) agrees with Wilson’s conclusions with regard to high mortality rates, and that homeless people are three to four times more likely to die than the general population. The risk is greatly increased in those homeless persons between the ages of 18 and 54, and that younger homeless women are four to 31 times more likely to die than their housed counterparts. Life expectancy in the general population is 78 years of age, and falls to between 42 and 52 years of age for the homeless population (O’Connell, 2005). Approximately 9 to 15% of the US population becomes homeless during their lifetime. Those who are truly without a place to stay and are considered literally homeless may be included in this figure, although the homeless are transient and in and out of shelters. Additionally, this figure may include those who HUD calls â€Å"doubled up† or â€Å"couch-homeless†. Other developed countries have a lower rate of this ategory of homelessness than the United States (Hoback and Anderson, n. d. ). For the U. S. overall in 2000, the estimate is 1. 65% of the population is â€Å"couch-homeless† (Census Bureau, 2000). One study highlights the Columbia-Harlem Homeless Medical Partnership (CHHMP), a free clinic run by students, that targets Manhattan’s homeless, providing medical students with a service learning opportunity and simultaneously, providing a medical home for homeless patients. Free student-run clinics are an integral piece of the medical safety net. In these learning settings, the requirements of medical students and in-need patients transect with the outcome of quality medical care. The disordered lifestyle of the homeless patient requires outreach to this population and a need for relationship building. This type of need is not feasible in the medical school setting but can be met at a student-run free clinic. Students are able to deal with the human side of public health disparity and learn more about other services and make referrals that can assist the whole patient, such as housing, health screenings, mental health providers, etc. (Batra, et al. , 2009). In congruency with the independent variable of other options stated earlier, an interview study of 2578 homeless and sporadically housed persons indicated that housing instability, abuse, multiple arrests, physical and mental conditions, as well as substance abuse were contributing forces to causing heightened usage of emergency rooms with a trial study group revealing on average seven visits per year. Galwankar (2004) and Whitbeck (2009) both conducted studies which emphasized the need to decrease emergency room use among the homeless populations, by focusing on identified risk factors from a public health standpoint (Galwankar, 2004). A large percentage of the homeless use hospital emergency departments for their primary care, even though it is not the most effective method of medical care for them, as it cannot provide continuity. Additionally, for hospitals and governments it is not cost effective (Whitbeck, 2009). Independent variable: Age Eighty percent of free clinic patients are between the ages of 18-64; with 12% being children and elderly being eight percent (George Washington University Report to Congress, 2012). Two pieces of literature agree with he statistic that one in every six people ages 51 to 61 partaking in the National Academies Health and Retirement Survey who were at the start of the survey, uninsured, developed a new finding of stroke, cancer or heart disease, over the next six year period (Institute of Medicine, 2012; Inguanzo Kaplan, 2011). In agreement with an IOM report cited, a national trend study from 2007, looking at 10,088 uninsured older working age adults, found that this group is less likely to receive regular preventative screenings for breast cancer, prostate cancer and cholesterol that those with insurance in the same age group. Additionally, women who are uninsured or are on Medicaid have a more advanced stage of breast cancer at first diagnosis and lower survival rate than their counterparts who have private health coverage (Gerber, et al. , 2008). In a 2009 Kaiser report, 30 percent of people between the ages of 19 and 29, are uninsured, the highest proportion of any age group. Though the majority of these young adults are working, they experience lower pay scales, and often find health coverage too expensive for their budget. Most people in this age group reported they were in good health, but 10 percent indicated they were in poor or fair health; twice as many as those with medical insurance (Weaver, 2010). Now, in 2012, many of this age group, because of provisions under the Affordable Care Act, will now be able to remain a dependent on their parent’s insurance policy until age 26, thus likely reducing the high percentage of uninsured in this age group (The White House, 2010). The number of children nationwide with no healthcare coverage is on the rise, but the impact from being uninsured on a child’s health has not been heavily explored. According to a Journal of Public Health article, in 2006 over one million children became uninsured, raising the total to 9. 4 million, or 12. 1% of all children in the United States. The spike in numbers can be credited to decreases in employer health coverage without corresponding growths in support provided by Medicaid or the State Children’s Health Insurance Program (SCHIP) (Abdullah, 2010). One study analyzed information from more than 23 million children, under age 18, in the United States, using two large patient databases, to evaluate the effect of health care coverage status on pediatric hospital stays. The study resulted in findings that the rate of death for children who were uninsured was over 37 percent of the deaths studied (Abdullah, 2010). Hypotheses H1: The fewer options for medical treatment will influence an uninsured person to use a free clinic for health care. The more alternative options for medical treatment will influence less free clinic usage by an uninsured person. Other options is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H2: Hispanic ethnicity will influence an uninsured person to use a free clinic for their medical care needs. Hispanic ethnicity will not influence an uninsured person to use a free clinic for their medical care needs. Hispanic ethnicity is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H3: Homelessness will influence a person to visit a free clinic. Homelessness will not influence a person to visit a free clinic. Homelessness is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H4: Age is a factor that influences free clinic usage by the uninsured. Age does not influence free clinic usage by the uninsured. Age is an independent variable that has an inverse relationship with the dependent variable of free clinic usage by the uninsured. Chapter II: Methodology Design This study will concentrate on one central research question: What impacts do availability of other medical care options, Hispanic ethnicity, homelessness and age have on the usage of a free clinic by people who are uninsured? These questions will pose the following hypotheses: H1: The fewer options for medical treatment will influence an uninsured person to use a free clinic for health care. The more alternative options for medical treatment will influence less free clinic usage by an uninsured person. Access to other options is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H2: Hispanic ethnicity will influence an uninsured person to use a free clinic for their medical care needs. Hispanic ethnicity will not influence an uninsured person to use a free clinic for their medical care needs. Hispanic ethnicity is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H3: Homelessness will influence a person to visit a free clinic. Homelessness will not influence a person to visit a free clinic. Homelessness is an independent variable that has a direct relationship with the dependent variable of free clinic usage by the uninsured. H4: Age is a factor that influences free clinic usage by the uninsured. Age does not influence free clinic usage by the uninsured. Age is an independent variable that has an inverse relationship with the dependent variable of free clinic usage by the uninsured. A schematic model illustrates the correlation between these variables. The model can be reviewed in Appendix A. The research question and problem will be answered by using a survey design study conducted by a convenience sample over a six week period. The reason behind using a cross-sectional design is that data on all variables of interest can be collected at the same time and is an efficient method for a large group (O’Sullivan, Rassel Berner, 2008). The three page survey, written at a fifth grade level, in English and in Spanish, will make inquiries and gather information about the independent variables, and about the dependent variable. Attempts will be made to approach every patient signed in at the clinics during the study period. Internal and external validity, then, are important to maintain when surveying a sample population and asking questions on sensitive issues. The goal is to ensure that the independent variables of interest indeed caused changes to the dependent variable and not something else; along with certifying the outcomes are general of the population and can be reproduced in any location. The development and reliability of the research questions are integral to maintaining internal validity within the study. Cognitive pretesting of 10 patients will be performed before beginning the study to ensure the questions are commonly understood and to confirm that the survey questions are capturing the intended outcomes. Additionally, in order to ensure external validity, the results of the study can be implemented by other governments and non-profit agencies. Population/Sample The population for this study is patients visiting two free clinics in Shelby County, Alabama, ages 19-64. This limits the population to a specific age range of persons in the county, as it has been determined that those outside this age range are eligible for coverage through government offered insurance programs, even if they have not applied for it. A Shelby County Development Services Department Profile indicates from 2010 Census data; the population for Shelby County, Alabama is 195,084 residents. Of those approximately 7% are uninsured, equating to around 10,000 uninsured residents. County demographics reveal an almost even division of males (49. 3%) to females (50. 7%). 83. 6% of the population is white, 10. 6% is Black/African American and 1. 5% is Asian (See Appendix D). An anomaly in demographics is observed in ethnicity, specifically Hispanic/Latino residents who are documented at 4. % (8,389) of the total population with an additional 4. 2% who ‘speak non-English language at home’ and 1. 6% who ‘speak English less than ‘very well. ’ If the results of a University of Alabama at Birmingham study are applied to undocumented Hispanics in Shelby County, the total would be more accurately reported at 37,314 (Patino, 2002). Given the fact that both clinics have eligibility requirement for the pa tients they see, the sampling frame will include only people ages 19-64, who have no insurance and who reside in Shelby County or indicate they are homeless. The sample will consist of those who randomly visit the clinic, and are signed in on a first come, first served basis and are waiting to receive treatment at the clinics during the study period, representative of the near 2000 patients who actually received treatment in 2011. This total number of patients is captured from clinic data gathered and reported by the clinics. The sample will be chosen through convenience sampling methods. This method was chosen for its ease of execution and cost effectiveness, although it has a higher risk of bias. The sample size was chosen using a formula that calculated a 95 percent confidence level that the sample size will accurately represent the total population of patients. The sample size will be 563 patients. See Appendix B. Variables Dependent Variable For this study, a free clinic is operationally defined as being a privately run non-profit agency not receiving any federal funding, that offers general medical services, medication and dental care to individuals who have no health care coverage. Volunteer, licensed medical providers administer the care at minimal or no cost (Darnell, 2010). The dependent variable is measured using nominal scales, with letters of the alphabet used as labels instead of numerals. Questions in the survey that address the dependent variable specifically are Question 4 and Questions 9-13 (see Appendix C). Independent Variables The first independent variable: lack of other options, can be conceptually defined as locations where the uninsured might seek medical treatment, other than a free clinic. To measure this variable, use of other options will be measured using a series of questions asking questions related to medical care history. Since the survey will be given to uninsured patients who may not have a high level of education, literacy, or understanding of terminology, the operational definition for the second independent variable of housing status in the survey will measure living arrangements. This will be accomplished by measuring the frequency of responses using nominal scales. The third independent variable, ethnicity, especially Hispanic ethnicity, has been defined as being of Hispanic origin. Per the US Census Bureau, persons of Hispanic origin are determined on the basis of question that asked for self-identification of the person’s origin or descent. Persons of Hispanic origin, in particular, are those who indicated that their origin was Mexican-American, Chicano, Mexican, Mexicano, Puerto Rican, Cuban, Central or South American, or other Hispanic (U. S. Census Bureau). The fourth and final independent variable, used in this model is age, and is intended to measure which age groups of working age adults visit a free clinic most often; and if age is a factor for visiting the clinic. In the study, variable is operationally defined as working age adults between the ages of 19-64. Free clinics trends have shown most patients are non-elderly adults (Darnell, 2010). This will be accomplished by measuring the frequency of responses using nominal scales. Data Collection Measuring Instrument The use of free clinics by the uninsured between ages of 19-64 and the relationships of the factors that influence usage, will be gauged by using a survey comprised of 20 questions (Appendix C), consisting of issues related to accessibility, reasons for use, medical insurance status, health status, employment status, housing status, current diagnoses, and general demographic information. These questions include both ordinal and nominal scales. Two questions will provide an open-ended answer option where space will be provided to write in an answer. Some questions for the survey were extracted from previously tested and validated instruments, such as the National Health Interview Survey. The survey will be translated into Spanish, and for those who need assistance, an already on-site Spanish interpreter will assist in the introduction of the study as well as offer explanation for completion of the survey. The survey should take no longer than 10 minutes to complete. Materials The materials and expense necessary to execute the survey are marginal. Copies required for each respondent total 4 pages (one page is the introduction and confidentiality notice and three pages for the survey) each totaling 2252 multiplied by $. 05 equals approximately $112. 60. Office supplies including three dozen writing pens and a stapler and staples will also be purchased for around $25. 00. Additionally, incentives in the form of refreshments are an additional cost. Bottled water and healthy snacks such as granola bars, pretzels or crackers will be purchased in volume to reduce costs. 25 cases of water totals $180. 00 and snacks will be approximately $150. 00. Therefore the total cost to administer the survey with incentive is approximately $467. 60. The study will be given during clinic operating hours where clinic volunteers will be recruited to administer the introduction and surveys providing additional cost savings. Delivery Method In order to allow every patient in the convenience sample the same opportunity to participate in the survey, upon their arrival and egistration, a clinic caseworker will share with them a scripted introduction explaining the purpose for the survey and assure them it is voluntary and it will in no way cause them any risk and will in no way compromise their clinic visit nor treatment. The introduction will also discuss confidentiality. These measures will help to ensure internal validity since the orientation may p rovide a level of comfort for the respondent who in turn may be inclined to answer the questions more honestly. The survey will be administered to the patients during regular clinic hours on Mondays between 8:30 am and 4:30 pm and Thursdays between 5:30 pm and 8:30 pm, while they wait to be seen. To improve response rates, healthy refreshments will be provided to participants. Patients who have been waiting to register for hours, to be one of 30 patients seen during a given clinic, have likely not eaten and may welcome refreshment as incentive to participate in the study. Dr. Eleanor Singer, a population studies professor and researcher at Columbia University summarized the evidence on incentives from the standpoint of the survey literature in the use of incentives in her 2002 book. She uncovered that incentives improve response rates across all approaches. The effect has proven to be undeviating, larger incentives have superior effects on response rates. Those patients who are first in line to see a medical provider will have equal opportunity to participate in the incentive and the study upon completion of their visit. Data Analysis Once the surveys are collected the data will first be cleaned. It is very important that the data collected from the surveys be able to be interpreted properly in order to accurately measure the relationships between the dependent and independent variables. Each question on the survey will be coded with a value prior to being administered. Data will be entered into a SDSS program and a multiple aggression analysis will be performed. From this analysis it will be possible to find the correlating relationships between each individual independent variable and the dependent variable to show significance. Ultimately the computer program will show which factors strongly influence free clinic usage, which ones are less influential and which factors together may increase the relationship further. See the example in Appendix E. Chapter III: Anticipated Findings The literature that has been reviewed in relation to the variables in this study, along with the suggested approaches, in tandem offers backing to the outcomes that are expected of this study. It is anticipated that there will be a relationship between use of a free clinic by the uninsured and each of the four independent variables provided: lack of other options for health care, age, Hispanic ethnicity and homelessness. The expectation is that the computer software used in analyzing the findings will show relationships between the variables, contradicting the null hypotheses. A multiple aggression analysis would be used to show these relationships by entering the data into a computer program designed to perform the computations and ends up showing a prototype of realism (Simon, 2003). Each of the four independent variables, are believed to have direct relationships with the dependent variable. Ultimately, it is anticipated that each of the four corresponding hypotheses will be conclusive. Chapter IV: Conclusion Studies provide support for the need to address reasoning behind free clinic usage by the uninsured population. The literature review has assisted in understanding each variable’s definition, emphasizing the ideas and findings of other scholarly studies, and establishing the integrity of the links between each independent variable and the dependent variable. As an example, the Kaiser report assists with understanding of the independent variable of age being a factor in why uninsured use a free clinic for their health care needs. It showed that younger working age adults in a certain age range were the group who are most often uninsured, and that this age group is forced to use free health care or have none at all, ultimately having medical conditions worsen, thus costing hospitals and tax payers more in the end. There is currently a staggering estimated $70 billion in uncompensated medical care from 2008 alone by uninsured patients (US Dept. f Health and Human Services, 2011). Therefore it is imperative that those with no medical insurance have access to some form of free or affordable health care in their community, with free clinics being an important piece of the equation. Implications The findings of this research are expected to be beneficial to the Shelby County local government, health and human service non-profit agencies and the medical system as the study will be proving assumed information, along with providing ancillary supportive data about the health care needs and gaps to serve uninsured residents of Shelby County, Alabama. In knowing information about what factors contribute to the free clinic usage among the uninsured, the community collaborative can propose modifications, improvements and additions for programming that may assist in lessening the burden, and ultimately solving the problem. While the outcomes from the study may not be exact to national trends, they should be very reflective and allow for reproduction of successful interventions. Recommendations The provided research will give evidence on four factors that contribute to the use of free clinics for medical treatment by the uninsured population of Shelby County, Alabama thus allowing for a community collaborative to be formed from local government, health care providers, faith based community, caseworkers, immigration and homelessness advocates, university department heads and others. Therefore, it is strongly suggested that this study be performed in order to gather this necessary information to determine if a more detailed needs assessment should be conducted. While there are additional independent variables that may contribute to the usage of a free clinic, only four have been highlighted for this study. Others additional factors should be investigated to identify other challenges that strain the health care system, ultimately contributing to the occurrence of free clinic use. REFERENCES Abdullah, F. et al. , (2009). Analysis of 23 million US hospitalizations: uninsured children have higher all-cause in-hospital mortality. Journal of Public Health, 32 (2), 236–244. doi:10. 093/pubmed/fdp099 Batra, P. , Chertok, J. , Fisher, C. , Manseau, M. , Manuelli, V. , Spears, J. (2009). The Columbia-Harlem homeless medical partnership: A new model for learning in the service of those in medical need. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 86 (5). doi:10. 1007/s11524-009-9386-z Becker, G. , (2001). Effects of being uninsured on ethnic minorities’ management of chronic illness. West Journal of Medicine, 1 75(1), 19–23. Corso, P. Fertig, A. , (2011). ROI and free clinics in Georgia. HealthVoices, University of Georgia College of Public Health, Healthcare Georgia Foundation, Publication 51. Darnell, J. S. (2010). Free clinics in the United States: A nationwide survey. ARCH Intern Medicine, 170 (11), 946-956. Depaul, J. (2010). Free clinics: America’s best-kept secret. The Fiscal Times. Retrieved from: http://www. thefiscaltimes. com/Articles/2010/05/03/Free-Clinics-Lifeline-for-America. aspx#page1 Fertig, A. , Corso, P. , Balasubramaniam, D. (2011). Benefits and costs of a free community-based primary care clinic. Retrieved from: http://hogwarts. spia. uga. edu/~afertig/policy1/FreeClinic_JHHSArevision_singlespace1. pdf Galwankar, S. , (2004). Role of homeless and uninsured patients in overcrowded emergency departments. Retrieved from: http://www. bmj. com/rapid-response/2011/10/30/role-homeless-and-uninsured-patients-overcrowded-emergency-departments George Washington University, Department of Health Policy, School of Public Health and Health Services (2012). Quality incentives for federally qualified health centers, rural health clinics and free clinics: A report to Congress. Washington, DC. Gerber, R. et al. , (2008). A place to be healthy: Blueprint for a new free clinic for the medically uninsured of Rhode Island. Medicine Health/Rhode Island, 91(4), 105-108. Gertz, A. , Frank,S. Blixen, C. (2011). A survey of patients and providers at free clinics across the United States. Journal of Community Health, 36, 83-93. doi: 10. 1007/s 10900-010-9286-x Groman, R. , (2004). American College of Physicians white paper on the cost of lack of health insurance [White Paper]. Retrieved from: http://www. acponline. rg/advocacy/where_we_stand/access/cost. pdf Hoback, A. Anderson, S. (n. d. ). Proposed method for estimating local population of precariously housed. Retrieved from: http://www. nationalhomeless. org/publications/precariouslyhoused/index. html Inguanzo, M. Kaplan, M. , (2011). The social implications of health care reform: reducing access barriers to health care services for uninsured Hispanic and Latino Americans in the United States, Harvard Journal of Hispanic Policy, 23, 83. Institute of Medicine (2003). Hidden costs, values lost: Uninsurance in America. The National Academies Press. Washington, D. C. Retrieved from: http://www. nap. edu/catalog. php? record_id=10719 Isaacs, S. L. Jellinek, P, (2007). Is there a (volunteer) doctor in the house? Free clinics and volunteer physician referral networks in the United States. Health Affairs, 26 (3), 871-876. doi: 10. 1377/hlthaff. 23. 3. 871 Keis, R. M. , DeGeus, L. G. , Cashman, S. , Savageau, J. (2004). Characteristics of patients at three free clinics. Journal of Health Care for the Poor and Underserved, 15 (4), 603-617. Krisberg, K. , (2010). Jump in uninsured signals need to implement health reform: Economy takes a toll on health coverage. The Nation’s Health, 40 (9), Retrieved from: http://go. galegroup. com. libproxy. troy. edu/ps/i. do? id=GALE%7CA241780634v= 2. 1u=troy25957it=rp=AONEsw=w Lewis, J. H. , Andersen, R. M. Gelberg, L. , (November 2003). Health care for homeless women: Unmet needs and barriers to care. Journal of General Internal Medicine, 18, 921-928. Llano, R. , (2011). Immigrants and barriers to healthcare: Comparing policies in the United States and the United Kingdom. Stanford Journal of Public Health, Retrieved from: http://www. stanford. edu/group/sjph/cgi-bin/sjphsite/2011/06/immigrants-and-barriers-to-healthcare-comparing-policies-in-the-united-states-and-the-united-kingdom/ O’Connell, J. , (2005). Premature mortality in homeless populations: A review of the literature. National Health Care for the Homeless Council, Inc. , Nashville. Patino, F. , (2002). Material and child health services utilization by Hispanics in Alabama (doctoral dissertation). Birmingham, AL: The University of Alabama School of Public Health. Scariarti, P. Williams, C. , (2007). The utility of a health risk assessment in providing care for a rural free clinic population. Osteopathic Medicine Primary Care, 1(8). doi: 10. 1186/1750-4732-1-8 Simon, G. , (2003). Multiple regression basics. Retrieved from: http://people. stern. nyu. edu/wgreene/Statistics/MultipleRegressionBasicsCollection. pdf Singer, E. , (2002). The use of incentives to reduce nonresponse in household surveys. Survey Nonresponse, John Wiley Sons, Inc. , New York, 163-177. Trask, J. , (2011). The relationship between primary care access to free clinics and emergency room usage (Unpublished doctoral dissertation). Graduate College of the University of Illinois at Urbana-Champaign. United States Census Bureau (2001). Households and families 2000, Census 2000 brief. US Department of Commerce. United States Census Bureau. Hispanic population of the United States. Retrieved from http://www. census. gov/population/www/socdemo/hispanic/ho00def. html U. S. Department of Health and Human Services (2011). ASPE Research Brief: The value of health insurance: Few of the uninsured have adequate resources to pay potential hospital bills. Weaver, C. , (2010). How health overhaul would affect the uninsured. Kaiser Health News. Retrieved from: http://www. kaiserhealthnews. org/stories/2009/september/21/uninsured-explainer-npr. aspx Whelan, E. M, (2010). The importance of community health centers: Engines of economic activity and job creation. Center for American Progress. Whitbeck, L. (2009). Mental health and emerging adulthood among homeless young people. Psychology Press, Taylor Francis Group, New York. White House, (2010). Department of Health and Human Services. Retrieved from: http://www. whitehouse. ov/blog/2010/05/10/a-long-overdue-change-help-young-adults-get-coverage [pic] [pic] |Appendix B | | |Required Sample Size†  | | | | | | | | | | | | |   |0. 05 |0. 035 |0. 025 |0. 01 |   |0. 05 |0. 035 |0. 25 | |   | |10 |   |10 |10 |10 |10 |   |10 |10 |10 | | | |20 |   |19 |20 |20 |20 |   |19 |20 |20 | | | |30 |   |28 |29 |29 |30 |   |29 |29 |30 | | | |50 |   |44 |47 |48 |50 |   |47 |48 |49 | | | |75 |   | 63 |69 |72 |74 |   |67 |71 |73 | | | |100 |   |80 |89 |94 |99 |   |87 |93 |96 | | | |150 |   |108 |126 |137 |148 |   |122 |135 |142 | | | |200 |   |132 |160 |177 |196 |   |154 |174 |186 | | | |250 |   |152 |190 |215 |244 |   |182 |211 |229 | | | |300 |   |169 |217 |251 |291 |   |207 |246 |270 | | | |400 |   |196 |265 |318 |384 |   |250 |309 |348 | | | |500 |   |217 |306 |377 |475 |   |285 |365 |421 | | | |600 |   |234 |340 |432 |565 |   |315 |416 |490 | | | |700 |   |248 |370 |481 |653 |   |341 |462 |554 | | | |800 |   |260 |396 |526 |739 |   |363 |503 |615 | | | |900 |   |269 |419 |568 |823 |   |382 |541 |672 | | | |1,000 |   |278 |440 |606 |906 |   |399 |575 |727 | | | |1,200 |   |291 |474 |674 |1067 |   |427 |636 |827 | | | |1,500 |   |306 |515 |759 |1297 |   |460 |712 |959 | | | |2,000 |   |322 |563 |869 |1655 |   |498 |808 |1141 | | | |2,500 |   |333 |597 |952 |1984 |   |524 |879 |1288 | | | |3,500 |   |346 |64 1 |1068 |2565 |   |558 |977 |1510 | | | |5,000 |   |357 |678 |1176 |3288 |   |586 |1066 |1734 | | | |7,500 |   |365 |710 |1275 |4211 |   |610 |1147 |1960 | | | |10,000 |   |370 |727 |1332 |4899 |   |622 |1193 |2098 | | | |25,000 |   |378 |760 |1448 |6939 |   |646 |1285 |2399 | | | |50,000 |   |381 |772 |1491 |8056 |   |655 |1318 |2520 | | | |75,000 |   |382 |776 |1506 |8514 |   |658 |1330 |2563 | | | |100,000 |   |383 |778 |1513 |8762 |   |659 |1336 |2585 | | | |250,000 |   |384 |782 |1527 |9248 |   |662 |1347 |2626 | | | |500,000 |   |384 |783 |1532 |9423 |   |663 |1350 |2640 | | | | Appendix C Health Care Survey Questionnaire Circle your answer: 1. What is your age? a. 19-24 b. 25-34 c. 35-44 d. 45-54 e. 44-64 2. What would you classify your ethnicity? a. Caucasian or white b. African American or black c. Hispanic/Latino d. Asian e. Other________________ 3. What is your employment status? a. Full time employee b. Part time employee c. Self employed d. Unemployed – looking for work e. Unemployed f. Retired 4. Reason for no health care coverage/insurance? a. Employer does not offer b. Don’t work enough hours c. Became unemployed and lost coverage d. Cannot afford 5. What is your highest level of completed education? a. Did not complete High school/did not obtain GED b. High School Diploma / GED c. Technical/Trade school d. Some college e. College degree f. Graduate degree g. Doctoral degree 6. What is your housing status? a. Own home b. Rent home/apartment c. Live with family/friends d. Reside at shelter/transitional housing e. Not housed 7. What language do you speak most often at home? a. English b. Spanish c. Other__________________ 8. Are there children living in your household ages 18 and younger? a. Yes b. No 9. When was the last time you received medical care before today’s visit? a. Within last week b. Within last month c. Within last three months d. Within last six months e. Within last year f. Longer than one year 10. Where did you last receive medical treatment before today’s visit? a. Doctor office b. Hospital ER c. Public health department d. Free Clinic 11. Which best describes the reason you chose the location for your last medical treatment? a. Location b. Hours of operation c. Recommended by family/friend d. Did not know where to go 12. Did you have medical insurance the last time you received medical treatment? a. Yes b. No c. I don’t know 13. How would you rate your satisfaction level of your most recent medical treatment? a. Very satisfied b. Somewhat satisfied c. Somewhat dissatisfied d. Not satisfied 14. How would you describe your health? a. Excellent b. Good c. Fair d. Poor 15. Are you experiencing an ongoing health problem? a. Yes b. No c. I don’t know 16. Have you had a diagnosis for your health problem? a. Yes b. No c. I don’t know 17. Are you taking prescription medications? a. Yes b. No 18. If you are taking prescription medications, is a needed refill the reason for your visit today? a. Yes b. No c. Not applicable 19. How are you able to afford your medications? a. Medication assistance b. Lower cost generics c. Samples d. Self-pay full price e. I cannot afford them 20. Please discuss any other issues you are having where assistance may be needed, so referrals may be offered. 21. Please describe in detail what you hope to receive from your visit today. Appendix D [pic] Shelby County Development Services Profile Appendix E – Example of a Multiple Regression results chart [pic] [pic] How to cite What Influences Free Clinic Usage by the Uninsured, Essay examples

Effects of Religion on the 2000 Presidential Election free essay sample

A discussion of how religion had a significant role in the presidential campaigns of the year 2000 in the U.S. This paper demonstrates that religion and personal worldview played an increasingly public and important role among candidates and voters during the 2000 Presidential election process in the U.S. The author examines the influence religion had on various political parties such as Democrats, Republicans, and other parties. If the only stance one can take in public life is to remain mute about ones most deeply held beliefs, then the election process is diminished. The American public requires a basis for knowing and evaluating the core values that shape our leaders actions and policies. Without the increased role of religion in the presidential election process, voters would be forced to speculate as to what the underlying political philosophy of a potential president might be. If values rooted in religious tradition (or any other philosophical worldview, for that matter) are an important element of a candidates decision-making process, the public ought to know this. We will write a custom essay sample on Effects of Religion on the 2000 Presidential Election or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Religious discussion only helps in the selection of good leaders who desire to lead the country down a moral road.

A Ryan Air Report Tourism Essays

A Ryan Air Report Tourism Essays A Ryan Air Report Tourism Essay A Ryan Air Report Tourism Essay Introduction Ryan Air is a British based low-priced air hose that operates in the leisure travel industry, which makes up for 40 % of its operations. ( Beginning: Michael OLeary, Ryan Air Chairman ) . Ryan Air as an air hose operator has a huge where bulk of its usage in the leisure touristry industry. This study will concentrate on Ryan Air s strengths and capablenesss every bit good as its failing and possible menaces to its concern. A general analysis will be carried out on the air hose to place what cardinal issues faced by air hose besides an rating of the air travel industry will be looked at. The rating will look at possible menaces within the industry and what effects it might hold on Ryan Air in footings of profitableness. The study will besides look into what the industrial environment has to offer and that which Ryan Air as a concern can capitalize and utilize to its advantage. Finally the study will place selling schemes of how best to implement its operations in order to raise its game and enable the concern to be more competitory. 2.0 Strategic Environment Political issues EU statute law Governments Labor markets Social Changing consumer attitudes towards work and leisure Lifestyle alterations Economic Competition Technological Online system ( s ) Legal Regulation The environment in which Ryan Air operates in has become so greatly influenced by the PESTEL model. It is of import from a company position to look at this model and be able to analyze state of affairs in which it may happen itself both in its micro and macro environments. 2.1 Political Ryan Air and its concern has been greatly affected by political state of affairs in its industry late, the most powerful force that has affected the air hose is that of EU statute law. The air hose industry has been greatly affected by statute law late so much so that in Ryan Air instance it has decided to end one of its paths ( Brussels Charleroi to London ) because of the EU ruled that the air hose had been having illegal inducements to wing the path. This is a negative matter fore the air hose, which ruled the determination as a disaster . The ordinance is a cardinal issue for the company in that call offing the path which antecedently has flown daily means a 10 % bead in flights from Charleroi. This is a definite menace to the air hose because as Mr. OLeary puts it these capacity decreases are bad intelligence for clients at Brussels Charleroi ( Beginning: www.news.bbc.co.uk ) However the biggest concern for the air hose will be the estimated 4million Euros the company has bee n ordered to payback as a consequence of the opinion. What seems even more distressing for the air hose is the sentiment from certain members of the imperativeness seem to believe that the air hose was let off rather lightly. A subdivision of the European imperativeness reappraisal commented the air hose comes out rather good and matters could hold been worse . ( Beginning: Swiss Le Temps ) The opinion seems to come at a bad clip for consumers in that it threatens to set monetary values up. A rise in monetary values may reflect to a menace to Ryan Air in that consumers may exchange to other inexpensive alternate methods of travel for the path. Ryan Air has pushed the issue of constructing a new airdrome terminus in Dublin, the air hose has urged Aer Rianta ( Irish Airports Authority ) to halt haltering the state s recovery through what it calls a monopoly on landing charges and paths. This is a cardinal issue for Ryan Air in that it is an chance for the air hose to work and with its success can maximize profitableness and enable cost efficiency. In February, the authorities approved the building of the new edifice nevertheless the recommends the terminus to be run by Aer Rianta much to the disillusion of the Airline who have declared an involvement in building and running the terminus. Ryan Air sees the chance of a new terminus as a opportunity for cheaper landing charges and faster turnaround times . The air hose sees what it calls a monopoly as inefficient , high-cost ; it believes the civil servant-run airdrome shackles Ireland opportunities of hiking its touristry industry. ( Beginning: www.news.bbc.co.uk ) Furthe r possible chances have been handed to Ryan Air in July Ireland Minster for Sports, Education and Tourism allocated the amount of 3m euros to hike Irish touristry to the abroad market. This is an chance for the air hose because with proper usage of the allocated financess its success will pull more touristry to the part and therefore more possible clients for Ryan Air. 2.2 Social Mintel Analysts have carried out studies and it seems that Britishers have more clip to save . Analysts carried out studies in 2004 37 % of Britons want more vacations and 45 % said they would wish to pass more clip with their households. It might be safe to state that this reflects alterations in attitudes of possible consumers. This is an chance for Ryan Air and so a cardinal issue because it can heighten the air hoses profitableness. Appoint which was further emphasised by the fact that outgo in abroad vacations has more than doubled between 1993 and 2003 from ?9bn to ?20bn. ( Beginning: Mintel ) 2.3 Economic Ryan Air has faced addition competition because of the EU opinion against them sing the Brussels Charleroi issue. The air hose finally decided to axe the path get downing on the 29 April 2004, the consequence of Ryan Air drawing out of the path has opened doors for two new rivals who have decide to get down winging from that path. Axis Airways ( a Gallic house ) and Air Polonia ( Polish Airliner ) regional beginnings said that the EU opinion has helped the sign languages. This is an obvious menace to Ryan Air because of the obvious loss of concern of one of its most flown paths due to the fact that it has the lowest menu. Monsieur Serge Kubla, the economic Minister thinks the airdrome had been seeking to diversify the airdromes activities by pulling air hoses other than Ryan Air. There has yet been more bad intelligence for the air hose with its chief challenger ( in footings of options ) for the path has seen a significant addition in riders PRNewswire studies that Eurostar saw a record one-fourth of rider Numberss as travelers continued to exchange from air hoses. The study besides states that in February 2004 the Eurostar had seen an addition on the London Paris path market portion of 66 % from 58 % of the same period the old twelvemonth and even more so for the London Brussels route 52 % compared to the old twelvemonth s 38 % . The study states that air hoses such as Ryan Air, EasyJet and BA have experienced a loss of about 11 % . The study states that this is a consequence of air hoses cut downing the figure of flights operated between London and Brussels. ( www.independent.co.uk ) Economic downswing is speed uping the reorganization of most markets Indeed, it is merely with the recent coming together of the engineering revolution, the economic squeezing and the deregulating of markets that the existent impact is being felt. From air hoses to mortgages, from energy to frost pick, many industries are being shaken inverted by the new market kineticss. Whilst British Airways struggles to happen infinite to last, Ryan Air and Go are reshaping the economic sciences and outlooks of air hoses 2.4 Technology A cardinal issue for Ryan Air is the consequence of engineering on its operations ; the air hose uses the Internet for most of its engagements. Ryan Air would be badly affected were it system to crash or a virus. Ryan Air gain the importance of puting in engineering, Ryan Air s MIS director Martin Nygard, states Our IT systems are critical to the success of our concern . With Ryan Air.com one of the most visited web sites in Europe the air hose have chosen Systemhouse Technology Group to procure its computing machine systems all around Europe from Viruses. Nygard states If something were to impact our booking systems or our Call Centres, our clients could nt purchase their tickets If cardinal sections such as flight operations and technology ca nt entree their computing machine systems 247 so our aircraft would remain on the land. 3.0 Constraints and Capabilities 3.1 Competitive competition Ryan Air competes in the low-priced sector of the air hose industry, which is rather competitory. Ryan Air faces competition from air hoses such as EasyJet, Go and Buzz every bit good as other low-priced budget air hoses. Potential entrants into the low cost sector at the minute seem to be Virgin, proprietor Sir Richard Branson plans to drift Virgin Blue ( Virgin Low cost option ) and plans to establish its low-priced air hose venture in mid 2004. With the industry expected to turn new entrants are likely and competition will go rather ferocious. With all these factors, it is just to state that competitory competition in this sector is rather high. 3.2 Menace of entrants With the expected explosive growing of the market it likely to state the menace of entrants is rather likely, this has been farther enabled with EU deregulating. However any entrants into the market have to be major participants with fiscal backup to be able to vie with established names like Ryan Air and EasyJet. Although new entrants coming into the market is likely the menace it poses to Ryan Air is rather moderate due to the demand for significant fiscal backup 3.3 Menace of replacements In footings of replacements Ryan Air s chief competition will come from Rail links like the Eurostar and the fast rail nexus between Madrid and Seville. The other alternate agencies of travel, which can present a menace to Ryan Air, is travel by ferry. The turning country of concern for the air hose might be the fact Eurostar is basking an increased period of growing in footings of rider Numberss, which will ache the Paris, Brussels, and Charleroi paths. The menace of permutation might be further increased with the fact that British consumers have to an extent become in favor of vacationing within the state. In recent old ages the British have tended to see topographic points like Butlins, Blackpool and a host of other holiday locations within the UK. Ryan Air s response is its program to increase siting capacity in order to cut down costs and increase rider Numberss. Seemly it can be said that even though rail travel has experienced an addition it can be said that the menace of repl acements will be rather low due to the trouble of rail monetary values viing with low cost air hose monetary values. 3.4 Buyer power In the industry purchaser power seems to be high, because of the huge figure of purchasers within the sector. There seems to be an addition in rider Numberss in the low-priced air hose sector. With Ryan Air ruling the European selling low cost travel and seemly decreasing cost borders. It offers a certain chance for the air hose for farther enlargement and so market growing. There are besides rather a few operators in the industry such as EasyJet, Go and Buzz. This makes the market topographic point more competitory for monetary value as purchasers tend to look around for the best monetary value. 3.5 Supplier Power Ryan Air relies on Boeing to provide the aeroplanes and Rolls Royce for the engine parts. However Ryan Air are able to set up a clear advantage of challengers because it owns it planes alternatively of renting them. By having their aircraft Ryan Air is able to capitalize on care costs whereas renting would coerce the company into seting money aside which would blow up their care histories. The air hose has had increased orders from Boeing through which it has gained economic systems of graduated table. However Boeing is able to set up great supplier power due to the fact that most low cost air hoses favour the 737 scopes of aircraft. Ryan Air additions cost advantage because it burns less fuel capacity in comparing to hanker draw flights nevertheless this means that they are besides less capable of go throughing on cost ( of fuel monetary value addition ) to their monetary value witting section. In footings of provider power it can be said that Ryan Air have a reasonably low to medi um supplier power. 4.0 Key competences Ryan Air operations and concern endurance are based around one simple factor diminish cost borders . Bing able to remain in front of the game means being able to set up cardinal competences or competitory advantage ( s ) that can non be duplicated ( and if so ) with great trouble by challengers. Mr. OLeary believes the air hose s chief advantage on its challengers remains the ability to accomplish 25-minute turnarounds . ( Beginning: Financial times ) He suggests Ryan Air is able to run to two more flight runs that its challenger BA, he believe it is the air hose s most of import cost advantage . This is surely a cardinal competency for the air hose and one, which BA has non been able to double. In footings of other challengers such as EasyJet or Go, they excessively have schemes based on cost borders but have non been able to double them every bit good as Ryan Air have. The ultimate ground why Ryan Air still maintains its place as Europe s elite low cost air hose. Bing able to se t up a nucleus competency in within the market place depends on the ability to be able to set up Critical Success Factors ( CSFs ) . In Ryan Air s instance their CSFs are as follows Operational Excellence. Delivering quality service rapidly and for a sensible monetary value Operational excellence involves supplying the lowest-cost goods and services while at the same time understating jobs for the client. Ryan Air has continued to successfully decrease costs though different stairss and class of action. They decided to exchange 70 % of its Birmingham Airport Traffic to Nottingham East Airport as a cost step to counter what has been described as a 100 % addition in track charges. ( www.bbc.co.uk ) Management of efficient minutess. For greater efficiency and velocity, processes between providers and the administration are frequently integrated. Management of efficient minutess this relates to Ryan Air s ability O negotiate favorable rates with airdromes the air hose has been able to negociate. This might be the ground why Ryan Air s challengers welcomed the intelligence of the Brussels s determination. ABN Amro air power analyst said he expected to the opinion to do a fall in Ryan Air s net incomes . The statute law has put Ryan Air s capableness to negociate favorable trades in the hereafter. Analysts say that the opinion could gyrate and impact on other trades across Europe. Dedication to measurement systems. Ryan Air seems dedicated to operational excellence proctor and step all procedures, continually seeking for ways to cut down cost and better both service and quality. Ryan Air stays in front of the game by being able to double what it does best and that is by cut downing costs. It continually finds ways to cut down costs even though it has been criticised for some of its policies. As portion of its policy of continual cost decrease Ryan Air antecedently charged riders for utilizing a wheelchair a policy which was challenged in tribunal which led to Ryan Air adding a surcharge of 50p for each ticket to pay for the tribunal opinion which order the air hose to offer a free wheelchair service. Part of the air hose s continual policy has been to size up different airdromes in order to go on to cut down costs. The company in the last twelvemonth have discontinue traffic to specific airdromes every bit good as move to different airdromes in hunt of better economic systems. 5.0 Ryan Air primary and secondary activities Ryan Air has the ability to associate its primary activity of winging planes at a low cost to both its concern and its clients with well-balanced support activities that help understate cost to operations. Ryan Air s capablenesss are based on good direction and efficient cost operations. 5.1 Ryan Air Primary Activities Inbound logistics Supplier dialogues Ryan Air has been able to drive down provider costs by assuring big and continually turning projected rider Numberss. It is stated that Ryan Air continued effectivity is down to the negotiated contracts between the air hose and its providers. Part of the ground why Ryan Air has continued with its vigorous enlargement ( to heighten rider growing ) is down to the fact that it negotiated in order to procure lower monetary values from its providers. Operationss Flying to secondary airdromes The air hoses policy of winging to secondary and therefore less busy airdromes is a policy adopted by most low cost air hoses. However Ryan Air has managed to negociate favorable conditions in most of the airdromes it operates from. It has managed to renegociate airdrome care and managing contracts with its providers in return for presenting increased growing. Ryan Air besides has a limited fleet and its pilots fly more air stat mis compared to other challengers. This establishes a competitory advantage over most challengers because the fleet get paid based on public presentation and how many sectors ( within ordinance ) they fly daily ; this helps to understate costs and maximize efficiency. Outbound logistics It has set-up client links with its operations through the utilizations on technological promotion. Ryan Air s purpose has been to convey their services at the client s fingertips. This is besides one of the grounds it continues to bask its topographic point as the figure one in the no-frills sector. Selling and gross revenues Online engagements, limited usage of travel bureau services and monetary value publicities 90 % of Ryan Air s selling and gross revenues is done online this is why the air hose has invested to a great extent in anti-virus systems. The air hose has been able to derive a competitory advantage is because the online engagement system brings the air hose closer to the client . Knowing clients closely and working closely with spouses gives Ryan Air a clear advantage. Servicess low in-flight service Like all low cost air hoses Ryan Air provides a low in flight service, nevertheless the air hose sheds its costs by undertaking out services such as aircraft handling, fining and luggage handling. The air hose is able to command quality and safety at a minimal cost by undertaking out engine and heavy care work under its supervising. 5.2 Ryan Air support services Firm Infrastructure Ryan Air chief central office is based in Dublin, Ireland where rents are comparatively low compared to topographic points like Central London. It has other little regional offices ( bases ) around Britain and programs to open some abroad in topographic points like Sweden and Germany. Its concern operations are chiefly on the Internet, which reduces operations cost. The air hoses ability to understate its costs of operation frees up needed financess to drive its selling run, this puts it in a good place to work the market. Ryan Air operates 125 paths and has 9 bases ( 7 of which are non-home state ) . ( Beginning: www.Ryan Air.com ) Human resource direction The air hose recruits staff online and it is the lone manner the return on new staff, it has been known to bear down appliers recruitment fees . Its fleet operates a public presentation wage construction ; its fleet is rather limited because the air hose chooses to contract out services as a manner of deriving a competitory cost advantage over its challengers. Technology development The air hose has based a significant bulk of its engagements online every bit good as puting in anti-virus systems to protect its computing machine web booking system. It has besides taken steps such as puting up a call line known as Ryan Air Direct where clients use a telephone line to do engagements. The usage of technological promotions has allowed Ryan Air go direct to the client. Another selling tool the air hose hour angle implemented is besides a set-up a little dependence on travel agents to counter engineering failure and hazards with opening unfamiliar markets. The technological promotions have been cardinal to Ryan Air operations Procurement The air hose has been able to derive a competitory advantage through the dialogue of favorable trades. E.g. the air hose has been able to negociate the a trade which Boeing partially financess for retraining of pilots from the Boeing 737-200 to the 737-800 ( which it late acquired 50 ) . ( Beginning: Davy Stockbrokers ) 5.3 Importance of benchmarking activities Vs. Environment Market schemes are about choosing and suppressing the emerging landscapes. Implementing these schemes can be important to an administration. Selling schemes are about alining administrations to accomplish this, competitively and commercially. This requires strict analysis coupled with originative thought: to look beyond today s boundaries, to map out the best future beginnings of hard currency, to hold the assurance to travel where cipher else has gone, to do the instance for it in commercial linguistic communication, and to show the impact on long-run stockholder value. In for Ryan Air to accomplish this mammoth undertaking it has to benchmark its strength and failings to that of its environment. It has to analyze these environmental factors in order to be able to analyze its place within the industry and therefore put it in an advantageous place. Once Ryan Air has identified its place so it can continue in implementing selling schemes that can vouch its concern success and therefore maximize its potency. 6.0 Use of strength and weaknesses Vs. Environment Environment developments Strengths and failings EU ordinance Potential industry growing Increased consumer demand Changing environment ( Work vs. leisure ) Strengths The air hose has had to cover with EU ordinance every bit good as deregulating in recent old ages. It has managed to utilize its capablenesss through efficient operations direction to cover with job The budget industry is experience a period of possible growing. With that growing lies a great trade of chances for Ryan Air which it actively seems to be working with its ain rapid growing and with its place as market leader the air hose is absolutely positioned Increased demand in budget air hoses has lead to rapid enlargement by Ryan Air. Ryan Air continues to use cost control measures ( farther low frills ) in favor of more seats on planes. The rich person besides order a new scope of fleet all which are steps to get by with increased demand Analyst studies show an addition in leisure clip spent. This presents the air hose with an chance for more air travel. Ryan Air has punctually responded by taking a figure of market based determinations in order to consolidate its place in the industry Failings Ryan Air s policy of cost control has finally put the air hose at hazard. EU ordinance ruled subordinates it negotiated in Brussels as improper. The companies. Being excessively cost witting has finally put Ryan Air in a place of menace from challengers. Ryan Air announced it is to retreat free ice with paid for drinks farther addition no frills. This is an obvious menace for the air hose with challengers adding fringe benefits and major air hoses dismissing. Increased consumer demand has forced addition traffic, with Ryan Air pilots forced to wing more hours compared to rival pilots. An issue that continues to exasperate trade brotherhoods ( which Ryan Air employees do non belong ) further making labour market jobs for the air hose. 7.0 Selling schemes Cardinal selling schemes for Ryan Air is imperative in its chase to keep its position as the taking no-frills air hose. They involve choosing mark client groups and stipulating how to present value to these groups. Segmentation, Targeting, Differentiation and Positioning are all cardinal to effectual digital selling. Ryan Air has base most of its selling schemes by utilizing what is referred to as E-marketing , the air hose has identified its mark as tourists and concern people who are less concerned with the luxuries of travel and are more concerned with get to their finishs every bit speedy as possible as their chief precedence. The chief push of e-marketing scheme is taking determinations on the selective targeting of client groups and different signifiers of value bringing for online channels. Using methods such as Online gross revenues objective scheme Online CRM scheme Online value proposition scheme Online targeted range scheme. Ryan Air can aim clients with the exclusive aim of luring them to purchase online as the breaker the web site. 7.1 Online gross revenues objective Aim: to change over on-line visitants to purchase Focus: Achieving gross revenues online ( May be new or bing clients ) By utilizing this scheme, Ryan Air will promote site visitants to buy-online through selling, publicities, etc. As portion of this scheme, options to change over visitants to action are explored, i.e. first-time purchaser publicities, site design betterments, place page and landing page optimization. Event-triggered, automated electronic mails besides be used to change over possible gross revenues to sale. 7.2 Online CRM scheme Through the usage of this scheme Ryan Air can specifically concentrate on different facets of the client lifecycle for online clients in footings of: Acquisition by planing schemes to derive new clients to the air hose AND migrate bing clients across to online channels. Retention Using on-line channels ( web based ads popups, linkages from web page and web site ) to increase keeping and value of client to company. Reactivation Encouraging continued usage of the air hoses web site ( possibly through rank enrollment ) this might promote clients to maintain revisiting the web site and maintain up to day of the month with information such as publicities taking to subsequent monetary value alterations and/or new flight information. Customer cognition ( familiarity ) larning more about the client through profiling and monitoring of behavior. This once more can be done through client records, which can be easy stored with, and on-line rank nevertheless data protection issues come into drama and Ryan Air must therefore stay by this. 7.3 Online targeted range scheme Aim: To pass on with relevant audiences online to accomplish Ryan Air s communications aims. These aims normally include: Building more trade name consciousness or favourability, driving on-line purchase, list-building or migrating bing clients to online channels. Focus: New client acquisition. This scheme purpose to pass on with selected client sections online identified by the air hose through media bargains, PR, electronic mail, viral runs and sponsorship or partnership agreements. Driven by aims of online audience portion and figure of site visitants in different sections. Philip Kotler supports this scheme of selling, suggesting that marketing s focal point should travel from pulling and retaining clients, to placing and working chances, conveying together markets and thoughts, introducing in the new marketspaces and taking the company with them, instead than gratifying to the bequest demands of worsening spheres.