Self-discovery in Desolation Angels Essay -- Desolation Angels Essays

Self-discovery in Desolation Angels Stripped to its barest essentials, Jack Kerouac's novel Desolation Angels reads as a drug-induced stupor of casual sex (or fantasies thereof), mixed into a melting of jazz and poetry. The often-adolescent urges of Kerouac's character Jack Duluoz, however, are mere episodes in the fast-paced, write-it-as-you-think-it, pre-literary notoriety phase in the life of a man who essentially founded the Beat generation. Though the overflowing stream of consciousness that comprises this book seems undoubtedly spontaneous, Desolation Angels actually examines, in a most straightforward and clearly organized manner, the state of human solitude. Zipping from a Forest Service mountaintop outpost to San Francisco, from Tangiers to London, and slipping from loneliness to jazz clubs full of "cats," from a morphine addict's room to the home of his knitting French Canadian mother, the angels of desolation take on varying shapes, ceaselessly trailing Duluoz/Kerouac. The novel begins as Duluoz/Kerouac ascends Desolation Peak on Starvation Ridge in the High Cascades for a seventy-day job as a lookout for forest fires. He initially anticipates with relish the idea of a seclusion that will allow him to ponder "the meaning of all this existence and suffering and going to and fro in vain" without the distractions of friends, drugs or alcohol Yet as the days dissolve into each other endlessly, he begins to tire of the monotony of Desolation. The stark emptiness greeting him from his outlook reflects the vacuity of life as he sees it. Entitled "Desolation in Solitude," this chapter records his mind patterns as he despairs over the "Void," an uncertain entity that symbolizes an eternal, vast, indifferent force of ... ...r undying devotion to him, and this seems to partially explain the source of his anger. He mourns the fact that a creature as wholesome and pure as she will inevitably grow old and die without leaving a mark on anyone but himself and his sister. Yet in accepting her mortality, he, for the first time in the book, finds an extended sense of peace. Throughout all of his earlier road trips and travels, he searched for serenity, only to be followed by Desolation. Here, finally, taking a bus across the country with strong yet innocent "Memere," does he leave them behind. In witnessing this change, the reader understands that constant movement cannot effect a sense of place, as Duluoz/Kerouac had thought throughout his transient excursions. Only facing our relationships with those we truly love can answer our questions regarding who we are in this mixed-up world. Â  

Social Phsycology

SOCIAL PSYCHOLOGY FINAL EXAMINATION (CH 12, 13, & 14) SPRING 2011 MULTIPLE CHOICE: 3 points each 1. An act performed voluntarily to help someone else when there is no expectation of receiving a reward is known as a. nurturance b. altruism c. pro-social behavior d. modeling 2. True altruism is defined by a. the circumstances surrounding the behavior b. the person's intentions c. the person himself or herself d. culture 3. Pro-social behavior is defined as a. any act that helps others, even if it is done to make yourself look good b. a voluntary act to help others with no thought of reward . helping that serves to perpetuate one's genes d. none of the above 4. Ethan volunteers to help with the local Special Olympics in order to build up his resume for job hunting.His behavior would best be described as a. prosocial behavior b. altruism c. reactance d. reciprocity 5. Researchers have found that we are most likely to be helpful to a. anyone who asks b. strangers c. friends d. all of the above 6. Which of the following is NOT one of the theoretical perspectives on helping described in the text? a. evolutionary psychology b. a learning approach c. a decision-making perspective . social impact theory 7. Evolutionary psychologists have observed that a. prosocial behavior is rare among non-human animals b. prosocial behavior is common among primates, but not in other animal species c. prosocial behavior is observed among animals only when a mother is protecting her young d. prosocial behavior is common among non-human animals8. Evolutionary theorists believe that altruism among animals and humans persists because a. helping provides the helper with emotional rewards b. helping increases survival value c. helping is rarely risky to the helper d. elping makes an individual appealing to potential sexual partners 9. The notion that any genetically determined trait that has a high survival value will tend to be passed on to the next generation is a cornerstone of a. evol utionary psychology b. genetic determinism c. learning theory d. the nature/nurture debate 10. Sociobiologist Robert Trivers has argued that only ________ is biologically based. a. prosocial behavior b. reactive altruism c. reciprocal altruism d. maternal altruism 11. Laws that require bystanders to an emergency to help a potential victim are based on a a. norm of reciprocity . norm of social justice c. norm of social responsibility d. diffusion of responsibility 12. Which country has the highest murder rate?a. Finland b. Great Britain c. Canada d. the United States 13. According to materials presented in your text, _____ percent of violent crimes are committed by strangers. a. 0. 6 b. 44 c. 56 d. 90 14. In explaining the origins of aggression, Freud focused on the concept of a. childhood learning b. pathological behavior c. instinct d. self-esteem 15. The definition of aggression as â€Å"any behavior that hurts others† would be the preferred definition of a. ognitive disson ance theorists b. exchange theorists c. social impact theorists d. learning theorists 16. One problem with a behaviorist definition of aggression is that does not take into account a. displacement b. learning history c. intentionsd. sanctioned aggression 17. An unprovoked criminal act that hurts others would be considered __________ aggression. a. prosocial b. sanctioned c. aggressive d. retaliation 18. You see a television news report featuring a policeman foiling a bank holdup by killing two of the robbers. This is a case of a. reactance b. sanctioned aggression . prosocial aggression d. frustration-aggression 19. You see a television news report featuring a shopkeeper who shot and killed a masked gunman who was trying to rob his store. This is a case of a. covert aggression b. prosocial aggression c. social exchange d. sanctioned aggression 20. One of the most common sources of ________ is an attack or intrusion by another person. a. frustration b. anger c. low self-esteem d. rea ctance 21. The interference with or blocking of the attainment of a goal is known as a. frustration b. normative blocking c. reactance d. anger 22.A child who sees an adult on television hitting another person and then hits his little brother is engaging in a. disinhibition b. dehumanization c. imitation d. aggression anxiety 23. The realization that health is a psychological as well as a physical issue has given rise to the field of a. epidemiology b. oncology c. psychological anthropology d. health psychology 24. The study of health psychology focuses on a. preventing and treating illnesses b. promoting and maintaining health c. improving the healthcare system d. all of the above 25. The _____ model says health is social, biological, and psychological. . psychosocial b. sociological c. sociobiological d. biopsychosocial 26. Annual cancer deaths in the United States could be reduced by _____ percent if everyone stopped smoking. a. 5-10 b. 25-30 C. 55-60 d. 85-90 27. Your text descr ibes disorders such as heart disease, cancer, and diabetes as a. preventable b. epidemic c. political d. ecological 28. Deaths due to vehicular accidents could be reduced by _____ percent if drunk driving were eliminated. a. 5 b. 20 c. 50 d. 85 29. Which of the following is described by your text as â€Å"preventable? † a. diabetes b. Heart disease c. Cancer d. All of the above 30.Which of the following is classified by your text as a â€Å"health behavior? † a. being no more than ten percent overweight b. not eating between meals c. eating breakfast each day d. all of the above 31. The reason many people do not engage in health behaviors is a. they do not know the behaviors most associated with better health b. they have biological predispositions that encourage unhealthy behavior c. the consequences of health behaviors often do not appear for many years d. all of the above32. Which of the following is NOT a basic health belief, as identified in your text? a. general health values b. sychological reactance c. self-efficacy d. personal vulnerability T/F (1point each) 33. It is very rare for people to offer help to strangers. F 34. Freud is the person most associated with evolutionary approaches to helping. F 35. An uneven distribution of economic resources in a country is associated with higher murder rates. T 36. Most scientists agree that aggression is learned; it does not come from inherited tendencies. F 37. Health beliefs have not done a very good job of predicting most health behaviors. F 38. Adolescents who engage in risky sexual behaviors are unlikely to use condoms consistently. T

The 1950s and Cold War Era Free Essay Example, 2750 words

The American government lost gold worth $8 billion due to the balance of trade during this period and hitherto, there has been a deficit in the economy (Vatter 264). The Federal Reserve Banks board of governors contributed to the 1950s inflation through their policies (Vatter 129). They depended on the general credit control quantitative tools such as open market operations, changes in the bank reserve ratios and the discount rate. This was in an attempt to react to the looming economic downturns and recession and restore price stability in the economy. Prices Of Commodities The prices of commodities significantly increased during this period and this contribution of many factors. One of such factors is the slackened productivity growth that was generally observed in the service sector, as a result, the elimination of price control after the World War II. Another main reason for increased prices of commodities was the Federal Reserve policy set by the Federal Reserve Bank in order to limit the American economy not to experience massive declines. The Federal Reserve Bank wanted the economy to experience only mild recessions instead. The other factor for increased commodity prices is the increased credit and demand by the consumers caused by the industrial sector’s poor productivity. We will write a custom essay sample on The 1950s and Cold War Era or any topic specifically for you Only $17.96 $11.86/pageorder now Other contributing factors were the significant rise in social security taxes and indirect taxes on businesses to almost double. Government Budget Classical budget maxims were then incorporated by the government with the aim of improving departmental efficiency, reducing the size of the budget and minimizing waste. The economic growth was generally entrusted to the hands of the private investors. During this era, the expenditures by the American government on defense and military decreased after the halt of the Korean War. These funds were, however, re-channeled to social welfare programs as well as airports and highway construction grants. These steps taken by the government resulted in a significant rise in taxes in the economy and a consequential rise in the services offered by the government. Business Sector Several developments in the business sector were experienced during this era, especially financial intermediaries and capital markets. There was an increase of 27% in the housing supply and a general rise in the quality of housing in America. Americans shifted from the suburbs to urban settlements due to rise in the level of living and health condition (Barach 57). There was increased consumer credit, industrial investments, and construction.

Pluralism Is Pluralistic Or Not - 2054 Words

Pluralism in America America as we see it today is a country with many different races, cultures, and religions all scattered out throughout the nation. You might not be able to tell but when you’re walking down the street there are people from all over the world that are walking around you, and not just that, there are people that may have the complete opposite religion that you have. You might not like that very well but it is a matter of America being pluralistic. In many people’s eyes America is not truly pluralistic, but the right people see that America is how you want it be. Meaning the people have to make the decision whether it is pluralistic or not, and it has not become a fact whether or not is or not yet. Pluralism is a society, system of government, or organization that has multiple groups to save their identities while being with other groups. Rather than having just one group or culture, determining how things are going to go, pluralism notices a larger n umber of fighting groups that think they all share the same power. Pluralism serves as a example of equality, where different groups can voice their opinions and ideas. There are many example of why America is not a truly defined nation yet and here is the first one. There are many different diversities that are all in America. Many people may not like the fact that they are living next to a Muslim family or a Jewish family but it is the way America is. The people who do not like that being the case ofShow MoreRelatedCultural Pluralism : As Educators What Pluralistic Perspective Do841 Words   |  4 PagesCultural Pluralism: As educators what pluralistic perspective do we use to motivate and encourage our students to learn in a classroom environment of other ethnic groups? Every teacher has a different teaching style. Identifying the best model of excellence in a pluralistic curriculum will increase good results in student achievement. Building Cultural Connections: †¢ Recognize Customs, Culture, and Religion †¢ Knowing and learning other cultural practices †¢ Knowing and understanding the differencesRead More The Defeat of Many by One Essay1421 Words   |  6 Pageseclectic family history of the Da-Gama Zogoiby family the central theme in the first two parts of the novel, Rushdie portrays India as a culturally and religiously pluralistic society. This pluralistic society is layered by violence caused by the corruption of multiplicity by various characters and the threat of Hindu fundamentalism. As pluralism is defeated by fascism in Part Three of the novel, the nature of the violence changes drastically and is symbolized by the Moor’s significant character change:Read MoreGould and Lewontins Essay The Spandrels of San Marco1052 Words   |  5 Pagesnatural selection as a key mechanism of evolution. The writers don’t see eye to eye with this thought and are trying to reassert a competing theory that organisms must be seen as integrated wholes. Gould and Lewontin show their explanations for a pluralistic perspective of the evolutionary theory through diction, quotations, and examples; they are able to persuade readers with their views. Through specific diction, Gould and Lewontin create a distinction between their views and the adaptationist programmeRead MoreInternational Research Symposium Accounting Information System1494 Words   |  6 Pagesto provide financial information for decision making and control (Vaassen, 2009). It is important to familiarise oneself with the following definitions in order to understand the terms used to address Accounting Information Systems. ‘ Agonistic Pluralism It is employed in developing alternatives accounting information systems Hetroglossic Accounting Used in a context where accounting information systems may be conceptualized. Critical Dialogic It refers to the facilitating democratic mechanismRead MoreThe Matrix ( 1999, Lana And Lilly Wachowski Essay1531 Words   |  7 PagesMatrix and the Problems of Pluralism† is an analysis of the film through the lens of theological meanings and pluralism. This paper will explore Bassham’s use of secondary evidence and transitions to make his claims of religious meaning and hidden pluralistic views in The Matrix believable and easy to follow, and how the effectiveness of his argument is weakened by its poor structure. To accomplish the feat of proving the existence of Christian, non-Christian and pluralistic themes within the filmRead MoreIdeal vs. Reality: Religious Pluralism vs. Religious Tolerance 1302 Words   |  6 Pagespeacefully in the city (Yellow Pages). Because Riverside is so diverse, religious pluralism and religious tolerance are two steps in making Riverside more connected. The first step is tolerance, a reflex that acknowledges a person will come across people of a different faith. The second step is pluralism, which is a better understanding of a person’s religion as well as the other religions around them. Many believe pluralism is the better of the two, because of the interaction involved and the creationRead MoreFour Political Theories Essay912 Words   |  4 Pagesaddresses the question of who holds power and the influences in the public. The theories include; The Pluralists Theory of Democracy,Hyper-pluralism, Elite Pluralism, and the Traditional theory. Althoug h each theory is completely different, they all exhibit the common idea;people, either as individuals or groups, can make a difference in government. The Pluralism theory has an affect on many aspects of America; Military spending, Education, and Healthcare for the elderly. The pluralist Theory denotesRead MoreThe Constitution Convention And The Ratification Debate Essay1196 Words   |  5 PagesGriffin Taylor POLS 355 Professor: Alan Buckley 9/21/2016 The Idea of Pluralism in the Constitution Convention and the ratification debate The constitutional conventions importance is indisputable, it is one of the biggest turning points in history and it is also an event that continues to affect politics to this day. It can’t be ignored, the constitutional convention has such a big historical significance and such a direct impact on America. People have tried to examine the workings behind theRead MoreThe New Negro, By Alain Locke1707 Words   |  7 PagesThroughout Alain Locke’s works â€Å"Values and Imperatives,† â€Å"Pluralism and Intellectual Democracy,† â€Å"Cultural Relativism and Ideological Peace,† â€Å"The New Negro,† and â€Å"Harlem,† I found there to be a number of reoccurring themes, such as absolutes, imperatives, values, and relativism and their place in pluralism. I am going to be focusing on all the aforementioned themes and showing how they are all intertwined into the principles of pluralism. What is an absolute? In â€Å"Values and Imperatives,† LockeRead MoreThe Pluralistic View : Is Jesus The Only Savior?1084 Words   |  5 PagesKrishni Ryland THEO 313-D04 Book Analysis 30 November 2015 The Pluralistic View: Is Jesus the Only Savior? Jesus said to him, â€Å"I am the way, the truth, and the life. No one comes to the Father except through Me. Is Jesus really the only Savior for the whole world? Some may find this ludicrous. How does one man save an entire creation? In addition to that, the only way for one to be saved is to go through Him. On the other hand if you were to ask any Christian this question, of course the answer

Jesus and the Social Status of Women - 751 Words

Every culture has its differences but the discriminating and chauvinistic behavioral traits remains the same and carries on throughout generations. Prejudice and Sexism can be traced all the way back to the biblical times when women were viewed as non-existent. But according to the article, â€Å"Jesus and the Social Status of Women†, the author Caleb Rosado addresses the fact that Jesus broke the cycle of oppression against women. He informs the audience that Jesus accepts everyone with open arms no matter where they were from or their social rank in society. In the article, Rosado explains how Jesus treated the women that He encounters and His attitudes towards them. During the time of the New Testament, women were ranked at the bottom†¦show more content†¦Jesus clearly demonstrated this while He was on earth. In conclusion, Jesus defied how society portrayed women. Their perspective of women derived from prejudice and sexism. Jesus establishes a foundation of equality for women and demonstrates how to live by the â€Å"Golden Rule†. In this article, I learned how Jesus broke the cycle of oppression towards women during the biblical times. Also, it helped me realized the difference between prejudice and sexism. I believe that it would definitely be a challenge to try to go against our natural impulsive ways of initially prejudging others. Last but not least, I would recommend this article to everyone. It not only provides insights to Jesus and His interactions with women, but also teaches a good moralShow MoreRela tedKaren Christina Langs The Gnostic Gospel1407 Words   |  6 Pagesdefine women? The perspectives from the past are way different from what we think nowadays. Although there may have some religious and cultures degrade women, the social status of women is becoming higher and higher. Back to the past, the social status of women was very low. They could not even go to school or work outside. According to â€Å"Images of Women in Early Buddhism and Christian Gnosticism†, Karen Christina Lang uses many Buddhist and Gnostic scriptures to examine how people see women in theRead MoreMark Reveal Jesuss Identity in the Gospel of Mark1182 Words   |  5 PagesIn the Gospel of Mark, Mark discloses the life of Jesus and his embodiment of God’s Kingdom. Throughout his Gospel, Mark focuses on accurately revealing Jesus’ identity to his readers, and explaining why Jesus was destined to die on the Cross. Mark uses his role as an arranger by employing a diverse array of lit erary tactics to highlight the lessons of his narrative. One of the most effective of these devices is intercalation—the process of sandwiching one story between the beginning and ending ofRead MoreWhat Can We Learn from Luke About Jesus’ Attitudes to Women? Essay1417 Words   |  6 PagesWhat can we learn from Luke about Jesus’ attitudes to women? In order to discuss what we can learn from Luke about Jesus’ attitudes to women we must first understand a little about Luke himself. According to Charpentier E (1981:81) Luke had been seen as the, ‘beloved physician’, which is also cited in Hayes, M A. and Gearon L (1998:145) whom further state that Luke travelled with Paul from Troas to Philippi in Greece, Paul, (Col 4:14) expressly calls him, ‘the beloved physician’. He was in factRead MoreThe Position of Women in Religious Scripture Essay1661 Words   |  7 Pagesposition that women have in religious scripture has given them a lesser spot in society. When God created a man it made sense to create his partner, the female. Because the man is created first and then the women from his rib, the female gender in religious scripture has been discriminated on. This is shown in the various books of the Old and New Testaments, teachings of Jesus Christ, and the Qur’an. First, the Old Testament illus trates women as the corrupter of men. Next, the teachings of Jesus show moreRead MoreModern American And Ancient Jewish Social Hierarchy Essay1405 Words   |  6 Pagesbecome a young adult. The disenfranchising of children occurred even back in the time of Jesus. One might question, what does God think about children. How does God’s view of children fit within society? This paper will equate the human constructs of modern American and ancient Jewish social hierarchy, specifically how children fit in, and differentiate them from God’s view of children. As part of the Jewish social structure, children were placed in low regard often filing in close to the bottom ofRead MoreFor many years after the death of Christ, Christianity had many sectarian groups until it was1000 Words   |  4 Pagesequality between men and women in their communities. They clashed with the orthodox community during the second to fourth century and their teachings were excluded from the canonical teachings known as the New Testament. The standardized scriptures influenced the doctrine known today as orthodox, or correct teachings (Bentley and Zeigler 251). The traditional orthodox beliefs that women are to be subordinate to men are a stark contrast to the early days of Christianity when women such as Mary MagdaleneRead MoreWomen Role in Christianity and Islam996 Words   |  4 PagesChristian church, starting with Jesus, women were important members of the movement. The examples of the manner of Jesus reveal his attitudes toward women and show repeatedly ho w he liberated and affirmed women. Both complementarians and egalitarians see Jesus as treating women with compassion, grace and dignity.[2] The gospels of the New Testament, especially Luke, often mention Jesus speaking to or helping women publicly and openly, contrary to the social norms of the time. Jesus had female followers whoRead MoreComparing Womens Roles in Christianity and Islam Essay1166 Words   |  5 PagesIslam. Christian believers create and sustain a relationship with God through direct two-way communication in prayer. The Book of Prayer and its Origins: The Bible is composed of both the book of Judaism and the story of Jesus’ life. Various authors wrote the 66 separate books containing the word of God. These circulated independently until the Council of Hippo compiled chosen books into the one volume Bible that is used by Christians. Read MoreChristian Faith Jesus Is The Father Of God Or The Son Of Man995 Words   |  4 PagesAssignment BIB 314 Fresno Pacific University/ North Campus Introduction According to Christian faith Jesus is the son of God or the son of man. To me He is my savior meaning he is the one that was sent to die on the cross for me and all of creation. I believe Jesus was able to feel and go through a lot of the struggles that so many of us go through every day. Jesus is my healer, he was beaten and bruised and because of it I believe that he healed me. He was a perfect example of howRead MoreWomen And The Modern Church929 Words   |  4 Pageswhether or not women should be in ministry is often a disputed one, and has become a polarizing issue for the modern church. This is not unusual as women’s role in the church has never been free of controversy. When discussing this issue, it is important to recognize that women have always played a role in ministry. However, this would not be the case had it not been for Jesus and his unusual treatment of women. Despite the opposing customs and social norms of his day, Jesus embraced women and the roles

Reaction report free essay sample

Effective communication is key to making any relationship work. Communication can be verbal (speaking), as well as non-verbal (facial expressions, body language, etc. ), and can dictate how compatible two people are, and how long a relationship may last. Communicating includes expressing emotions, interaction, touch and others that dictate how the relationship between two people will develop. Being able to open up to your partner, and covey your feelings allows for a better understanding, and greater rapport which are all important. Effective communication can be directly connected to Reiss’s wheel theory of love, and the four concepts that are part of the marriage market endogamy, exogamy, homogamy and heterogamy all of which can help explain fundamentals of relationships, as well as the different types. Effective communication has a close relationship with Reiss’s wheel theory of love. This wheel theory depicts the development of love as a spinning wheel. Consisting of 4 spokes rapport, self-revelation, mutual dependency, and fulfillment of the need for intimacy. We will write a custom essay sample on Reaction report or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Two of these components are directly connected to effective communication, rapport and self-revelation. Rapport is when two people meet there is a sense of â€Å"ease† and â€Å"understanding. † For rapport to occur, verbal communication, as well as body language is a key component in building this ease. I view rapport as somewhat of a spark between two individuals, and people must be able to have a conversation, and show effecting body language such as flirting, the right greeting (handshake, hug, etc. ) to make each other feel comfortable around each other to build the rapport. After rapport is built, this leads to self-revelation, the act of gaining trust and confidence in the relationship. I believe the key to gaining trust in a relationship is communicating effectively. If you are open with your partner and tell the truth about your past, lifestyle, etc. a sense of trust can build, and you begin to feel more confidence in the strength of the relationship. Effective communication as well as Reiss’s wheel theory of love have a close relationship with the four concepts that are part of the marriage market endogamy, exogamy, homogamy and heterogamy. The concept of exogamy is marrying outside of one’s family. It is important to have effective communication in this instance because growing up you learn how your family does things and live life. When your entering a relationship with someone, they have also grown up learning there style of life. Communicating effectively, and working together to combine different lifestyles is essential to making the relationship work. This is important in the self-revelation aspect of the wheel in building a trust and confidence in living and building a household with one another. This is also tied to becoming mutually dependent upon one another. Being mutually dependent means sharing a lifestyle, such as going on walks, sharing jokes, etc. Communicating with your partner while building a life of your own is a big part of what makes a relationship. Endogamy is the act of marrying someone in the same group as you (neighbors, work members, friends etc). In this situation a rapport is built before hand, leading to effective communication already being present when the relationship is being built. Knowing someone for a while before hand I believe can make a relationship stronger because you already know a lot about the individual, and have plenty of things to communicate about. Homogamy is choosing a mate with similar characteristics. These characteristics can included religious beliefs, political views, among others. In this type of relationship, it seems as if rapport would be high. People tend to feel more comfortable around individuals who share the same ideals and beliefs, and would be able to communicate with one another easily based on their beliefs. This is very beneficial in having someone to talk to that you have a lot in common with, as that is a great start in building a certain comfort level. Heterogamy is choosing a mate whose characteristics are different than your own. This is very similar to exogamy, where as your entering a relationship with new things, different beliefs, way of living, etc. and you must communicate to build a rapport, and comfort with your partner. You must live your life in compromise, and make sure you can adapt your life to make it comfortable for both.

Managed Care Essays (2289 words) - Healthcare Quality, Managed Care

Managed Care Chapter 3: Types of Managed Care Organization ? The distinction between health care providers and health care insurers have blurred substantially ? 10 Years ago managed care organizations were often referred to as alternative delivery systems ? Managed care is now the dominant form of health insurance coverage in the United States ? Managed care can mean managing the provider delivery system can be equivalent in its outcomes to managing the medical care delivered to the patient ? Managed care may not perfectly describe this current generation of financing vehicles, it provides a convenient shorthand description for the range of alternatives to traditional indemnity health insurance ? On one end of the continuum is managed indemnity with simple pre-certification of elective admission and large case management of catastrophic cases, superimposed on a traditional indemnity insurance plan ? Further along the continuum are PPOs, POSs, open-panel [individual practice association (IPA) type] HMOs, and closed-panel (group and staff model) HMOs TYPES OF MANAGED CARE ORGANIZATIONS AND COMMON ACRONYMS HMOs ? HMOs are organized health care systems that are responsible for both the financing are the delivery of a broad range of comprehensive health services to an enrolled population ? HMO health insurer and a health care delivery system ? HMOs are responsible for providing health care services to their covered members through affiliated providers, who are reimbursed under various methods ? HMOs must ensure that their members have access to covered health care services ? HMOs generally are responsible for ensuring the quality and appropriateness of the health services they provide to their members ? The five common models of HMOs are (1) staff, (2) group practice, (3) network, (4) IPA, and (5) direct contact PPOs ? PPOs are entities through which employer health benefit plans and health insurance carriers contract to purchase health care services for covered beneficiaries from a selected group of participating providers ? PPOs often limit the size of their participating provider panels and provide incentives for their covered individuals to use participating providers instead of other providers ? In contrast to individuals with traditional HMO coverage individuals with PPO coverage are permitted to use non-PPO providers ? PPOs sometimes are described as preferred provider arrangements (PPAs) ? PPA is used to describe a less formal relationship than PPO ? The term PPO implies that an organization exists, whereas a PPA may achieve the same goals as a PPO through an informal arrangement among providers and payers ? Key common characteristics of a PPO include: ? Select provider panel ? Negotiated payment rates ? Rapid payment terms ? Utilization management ? Consumer choice Exclusive Provider Organizations ? Exclusive provider organizations (EPOs) limit their beneficiaries to participating providers for any health care services ? The EPO generally does not cover services received from other providers, although their may be exceptions ? EPOs, like HMOs, require exclusive use of the EPO provider network and also use a gatekeeper approach to authorizing non-primary care services ? The difference between an HMO and an EPO is that the former is regulated by HMO laws and regulations, and the latter is regulated under insurance laws and regulations ? Employee Retirement Income Security Act of 1974 ? EPOs usually are implemented by employers (b/c it's cost efficient) POS Plans ? Hybrids of HMO and PPO models ? Characteristics include: ? Primary care physician are reimbursed through capitation payments (i.e. Fixed payment per member per month) ? An amount is with held from physician compensation that is paid contingent upon achievement of utilization or cost targets ? The primary care physician acts as a gatekeeper for referral and institutional medical services ? The member retains some coverage for services rendered that either are not authorized by the primary care physician or are delivered by non-participating providers Open Access or POS HMOs ? Provides some level of indemnity-type coverage along with the HMO coverage ? HMO members covered under these types of benefit plans may decide whether to use HMO benefits or indemnity-style benefits for each instance of care ? The member is allowed to make coverage choice at the point of service when medical care is needed ? Most POS plans experience between 65 percent and 85 percent in-network usage, thus retaining considerable cost control compared to indemnity-type plans ? There are two primary ways form an HMO to offer POS option 1) Via a single HMO license a. HMO provides the out-of-network benefit using its HMO license 2) Via a duel-license approach a. The health plan