Hasta La Gadget!

Two weeks ago, World of Children Award Honoree Nick Kristof, Op Ed columnist at The New York Times, blew the whistle on a website called backpoage.com, which according to the details in his article, has trafficked some 100,000 children (mostly girls) into the sex trade. This all took place in the USA, not some Third World country…right here in our backyard.

Sadly, the news about backpage.com is not new. In 2012 ABC News in Phoenix reported 51 arrests as a result of a police action against this web site and in 2013, NBC News also ran an expose on backpage.

So here are the questions: why have we heard so little about this? Why has the Federal Government not shut down this heinous operation?

To me the answer is simple. We are hypocritical when it comes to trafficking in the USA. We scream bloody murder when it occurs abroad but when it is here at home, well let’s just sweep it under the rug and act like it does not exist.

This morning’s news headlines included another brutal, senseless beheading by the thugs of ISIS, some possible scandal about political misuse of Twitter and a DEA investigation of NFL team doctors…but what about the 100,000 children being trafficked through backpage.com???

Silence, not a word.

More headlines covered a fall by the rock star Bono, a planned visit by the Pope to the US a full year from now and tennis star Roger Federer quitting a match due to injury…but what about the 100,000 young children whose lives have been destroyed through the backpage.com vehicle???

Silence, not a word.

These children — mostly girls, many as young as 13, 14, 15 — are forgotten, left to their fate while we ponder an injury to Bono or what the DEA found in NFL locker rooms.

Ralph Waldo Emerson wrote, “What lies before us and what lies behind us are but small matters compared to what lies within us.”

What does lie within us? Where is our sense of right and wrong? Where is our sense of values? Where is our outrage?

What lies within us?

We must become the voices for these children. So I ask everyone who sees this to express their outrage, to share this with every person they know and let’s become a virtual “mob” demanding justice in our own country for these defenseless children. Let’s let every news outlet and every legislator and every peace officer in the nation know that we are watching and waiting for them to take action.

This abuse of our children MUST be stopped and sooner rather than later.

What lies within us?

Part 1: India at the Crossroads in Its Quest to Achieve Universal Health Coverage — The Big Questions
(Part 2 explores which provider-purchaser approach is optimal for India.)

By Robert Hecht, Khizer Husain, Stephanie Sealy, and David de Ferranti

As India emerges from its recent elections, the new Prime Minister Narendra Modi and other senior officials face a series of major decisions on the future of the country’s health system. The previous government was committed to more than double public spending for health in a quest to achieve universal coverage over the coming decade. This provoked a strong debate regarding how much of this funding should flow through historic “supply-side” health budgets to government health facilities, and how much should be channeled into new “demand-side” mechanisms, especially government-sponsored health insurance in which there is a split between purchasers and providers of care.

What position will the new prime minister take on this issue, which is critical to the future of India’s 1.2 billion people? He has broadly indicated that he favors a continuation of the previous government’s policies of increased public spending and wider guaranteed health care coverage, but his exact position on the demand vs. supply-side focus and on public insurance is still unclear. The new finance minister’s budget speech, delivered on July 10, 2014, made no mention of health financing reforms and only referred briefly to boosting investment in other areas including research, medical colleges, regulatory bodies, and TB control. More recent pronouncements from August suggest that Mr. Modi favors an expansion of public insurance but remain vague on the details.

We would argue that based on India’s history and the state of its health sector and the lessons from global experience with a purchaser-provider split (PPS), we would argue that India should adopt a policy featuring non-competing state government health insurance pools, which purchase services from a mix of both public and private providers. If adopted, such a policy would generate significant improvements in access, quality of care, and efficiency for the country’s billion-plus citizens.
 
India’s quest for Universal Health Coverage
India’s Twelfth Five-Year Plan (2012 – 2017) takes a bold step towards universal health coverage (UHC), committing India to double public expenditure on health — from 1.2 percent to 2.5 percent of GDP over the next five years to over 3 percent by 2022. But how should these extra funds be deployed?

Supply-side approaches are the dominant form of government health financing in India today but have generally produced poor results in terms of health service coverage, outcomes, and client satisfaction. Partly in response to this situation, demand-side approaches have become more widespread in recent years, mainly through the emergence of Rashtriya Swasthya Bima Yojana (RSBY), a centrally-sponsored health insurance scheme, and the use of vouchers such as in the Janani Suraksha Yojana (JSY) program. The new tax-funded insurance schemes, summarized in Table 1, offer a paradigm for health financing that is different from India’s traditional supply-side approach: By targeting India’s most disadvantaged group, the below-poverty-line (BPL) population, they allow patients to access a mixture of accredited private and public hospitals using bundled rates of payment.
 
The fundamental question: purchaser-provider split?
The underlying policy question for India is whether some substantial part of the financing and purchasing of health care should be separated from the delivery of health services, or whether the two should be kept integrated under a single institution in each state. Unless policymakers opt for a PPS for a major share of health goods and services, the traditional Indian model of “supply-side” financing is likely to be followed: Public money will flow through state health ministry budgets and will be allocated to government health centers, hospitals, and other programs based on prior years’ allocations and not as a function of performance — quantity, quality, and efficiency of services provided.

If, alternatively, emerging and other possible forms of the PPS are pursued as the dominant approach at national level and in India’s states, the fundamental logic for health care financing in India will shift toward patients’ demand for (and use of) care. The door will open for public revenues to be pooled in state insurance funds, as has started to happen under RSBY, but on a larger scale. The managers of these funds could then purchase care from a mix of government and private providers using mechanisms that better promote access, efficiency, and quality.

Further questions on a PPS to achieve Universal Coverage
If a PPS is adopted as policy, Indian decision-makers will face three additional design questions: Should the purchasing agency in each state be attached to the health ministry or independent of it? Should it be a government entity or some kind of parastatal organization? And, should the government purchaser use private third party companies to carry out part of its work, such as contracting and claims adjudication, or should these functions be performed in-house by a government or quasi-public body?

We argue that demand-side financing and a PPS are needed to drive deep and lasting improvements in government-financed health care in India. If these instruments are not utilized, we do not think the country will be able to harness increased tax funding for health in an efficient and effective manner, overcoming the problems that have chronically plagued India’s public facilities: high levels of health worker absenteeism, shortages of medicines, and low quality of care.

India has a small but growing body of experience with PPSs under RSBY and several additional public insurance schemes tailored to the states of Andhra Pradesh, Tamil Nadu, and Karnataka. Evaluations to date show generally positive but mixed results. Some studies point to expanded health care utilization by the poor and improved patient satisfaction. Other studies indicate that RSBY may be leading to cost escalation and the use of medically unnecessary care, and cite cases of fraudulent practices by certain private hospitals which are participating in the schemes. These are problems that will need to addressed as India expands demand-side mechanisms incorporating a PPS.

(Please read part two, which explores the suitability of different provider-purchaser approaches for India.)

Breast assured, this experiment was pointless.

Two German radio DJs for JAM FM allowed a cosmetic surgeon to give them temporary boobs for 24 hours. What did John & Rasheed learn? Almost nothing.

WARNING: GRAPHIC VIDEO

After the pair was injected with 700ml of saline solution, they hit the gym, went bra shopping, and tried to get random women to feel them up.

“Bras are torture and every woman should get a medal for wearing this monster,” they posted on the station’s Facebook page.

Apparently, John & Rasheed are “known” for their wacky antics in Berlin. But we still wonder why. We were hoping for a deep and intellectual reflection on what it may feel like to have physical female qualities, but we got nothing. And for that reason, we urge these two to rethink their decision, and read the end of American Psycho:

“There is no catharsis. I gain no deeper knowledge about myself, no new understanding can be extracted from my telling. There has been no reason for me to tell you any of this. This confession has meant nothing.”

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One of the many challenges small businesses face today is integrating and managing Millennial employees with other generations of their workforce. Millennials are the newest generation of workers, and when they enter the job market they have specific expectations that your other staff may not. It’s important to remember that the Millennial generation is the future of your company, so now’s the time to learn how to manage this generation effectively to keep them performing at the highest levels within your company.

Who Are the Millennials?
Millennials were born between 1981 and 1994. They often display a high amount of self-confidence and believe in value for their work above all else. But unlike past generations, your Millennials are not overly independent. They often rely on their parents for career advice, and some may even live at home. When dealing with Millennials provide reinforcement and instant feedback, but remember that they may reach out to their parents for additional direction and advice.

Work/Life Balance
Millennials are not willing to give up their lifestyle for their careers. They value flexibility, which means you need to accommodate that lifestyle with different shifts, flexible hours, or even part-time work. Your average Millennial is not looking for the typical nine-to-five position. Instead, they want a career that allows them to enjoy the lifestyle to which they’re accustomed and gives them the opportunity to multitask — especially when it comes to technology.

What a Millennial Needs From Management
Downtime is viewed as a negative by Millennials, and so are positions that require monotonous work. While your Millennial employees may value their job, they value their time much more, so you need to ensure they feel like their making the most of it.

Most Millennials are team-oriented, so bringing them together in cooperative groups may be the best way to maximize their potential. Diversity is also important, since Millennials have grown up in a culturally diverse environment. Millennials also rely heavily on new technologies to communicate, so many prefer to use instant messaging, email, or even texting to communicate with management and other employees. Their generation looks at these forms of communication as quick and efficient. Lastly, your Millennials demand feedback (both positive and negative). They need to know where they stand at all times.

How to Manage Your Millennial Staff
• Recruitment: You want to emphasize how your small business contributes to society and how the position will benefit their careers.
• Work management: Effectively managing Millennial employees also requires you to give them multiple tasks to be done at once. Unlike other generations, Millennials look for and thrive in situations where they can multi-task. They also want to work in an environment where they can collaborate and work closely with others. While you’ll want to hold them accountable for their mistakes, at the same time you should work to bring out their better qualities and help them develop the skills they need to improve.
• Work environment: Offer flexible work schedules and a relaxed work environment. Provide regular opportunities for socializing. You’ll find that while they socialize, they are also working–comparing notes, discussing and brainstorming various options for getting work done, etc.
• Learning opportunities: Tuition reimbursement is highly valued by the Millennial generation, as is employee training so that they can further their skills.
• Motivational tools: Millennials value time and rewards, so offer paid time off, bonuses, and/or gift certificates.

Managing Millennials takes time and, for your small business, may mean making significant adjustments. But since they’re the future of your company, those management changes will eventually pay off. Their fresh ideas and ways of working will definitely benefit the company as a whole and encourage their loyalty.

Margaret Jacoby, SPHR, is the founder and president of MJ Management Solutions,a human resources consulting firm that provides small businesses with a wide range of virtual and onsite HR solutions to meet their immediate and long-term needs. From ensuring legal compliance to writing customized employee handbooks to conducting sexual harassment training, businesses depend on our expertise and cost-effective human resources services to help them thrive. This article first appeared on the MJ Management Solutions blog.

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Part 2: Which Purchaser-Provider Models Are Best for India?
(Part 1 provides background on the issues.)

By Robert Hecht, Khizer Husain, Stephanie Sealy, and David de Ferranti

In recent years, countries globally have re-examined and revamped the relationship between purchasers and providers of health care. Some, like Sri Lanka and Cuba, have chosen to maintain direct government control rather than opt for a purchaser-provider split (PPS). Most others, including nearly all OECD nations and many countries in East Asia, Latin America, and increasingly in Africa, have elected to design and implement a provider-purchaser split (PPS) as part of their health financing system reforms.

Building on the work of Xu and van de Ven, we see four types of PPS models available to India as shown in Table 2.

By using public insurance funds to purchase exclusively from government health care providers (Model 1), as in the U.K., India could create positive health results by requiring public hospitals and health centers to deliver specified volumes and certain quality standards of care. A disadvantage of Model 1 for India is the country’s relatively low utilization of the public sector, which delivers just one-fifth of all outpatient care and less than half of hospital services.

In this regard, Model 2 (public insurance and mixed private and government delivery of care), as in countries like Canada, is better suited to India’s conditions today. This model, exemplified by the long-standing but small Central Government Health Insurance Scheme for civil servants and more recently by RSBY, aligns with India’s current mixed public-private health care delivery system. By including both qualified government and private health providers, consumers will have wider choice, and providers will face competitive pressures to perform better.

The rationale for adopting this model is bolstered by recent studies of India’s public insurance schemes, which find a high patient satisfaction rate, effective coverage for tens of millions of India’s poorest, and increasing financial protection. The studies also suggest that stronger monitoring and regulatory oversight are needed to enhance the impact of these schemes, reducing fraud and price escalation.

For India to successfully adopt this model, states will need to strengthen their public health insurance funds with skilled staff and additional purchasing know-how. Currently, private intermediaries are contracted by the states to enroll members, empanel hospitals, process claims, and reimburse hospitals. If Model 2 is to be fully implemented, parastatal institutions (trusts and societies, and state nodal agencies) will need to play a progressively stronger role as active purchasers.

An alternative might be for the newer government tax-financed schemes to rely on private insurance companies for purchasing functions (Model 3), as in Germany. Most of India’s new public insurance schemes, including RSBY and more ambitious programs in Andhra Pradesh, Karnataka, and Tamil Nadu have contracted with private insurance companies and third-party administrators, which set payment rates and process claims.

A key modification would be to insist that the private intermediaries managing the purchasing function be not-for-profit entities, as with the “sickness funds” in Germany and Japan, and that these intermediaries work collaboratively with the government, providers, and civil society organizations to set mutually agreed payment rates for a standard package of benefits.

Model 4, entailing competition among private entities purchasing on behalf of a public insurance scheme, as in Colombia and the Netherlands, is not well suited to prevailing conditions in India. It would require developing risk equalization mechanisms in each state and further regulating competing private insurance companies, to ensure that they do not try to avoid high risk patients and select only the healthiest customers (cream-skimming). This would place excessive demands on public regulatory agencies at a time when they are still nascent in India.

The Way Forward
We therefore suggest that India pursue a PPS approach along the lines of Models 2 and 3, in which non-competing tax-financed public insurance agencies purchase care from a mix of public and private providers. These agencies could be public sector or parastatal agencies (Model 2) or regulated non-profit private entities (Model 3).

On the provision side, states like Tamil Nadu and Kerala, which have strong government health systems, could purchase health care from public hospitals and clinics, while in other states with weaker government health services and predominantly private providers, the major share of the purchasing might be from private sector.

Such a purchaser-provider split would allow Indian consumers to access the providers they prefer, while giving purchasers leverage to demand better quality, lower cost services. We see this as the best way for India to use its growing public purse to improve the health of its population.

The main arguments against a PPS in India are that private providers would exploit patients’ ignorance and purchasing institutions’ weakness to order costly medically unnecessary services; or, even worse, that the purchasers (especially where they are government-contracted private companies) would collude with private hospitals and doctors to bankrupt the system. While we acknowledge these as risks, we believe that through increasing public sector control and professionalization of purchasing, and stronger regulation of all providers, these risks can be effectively managed in India.

Whatever form of PPS Indian states decide to implement, they will need to take further steps to make their public insurance schemes truly universal. This means expanding the pool of eligible beneficiaries beyond families below the poverty line, to include all households. RSBY is beginning to do this, by incorporating other lower-income groups such as street vendors, taxi drivers, and sanitation workers.

Reaching universal coverage for the Indian public insurance schemes will also require broadening the benefits package to include a wider range of services. At present, RSBY and most state-sponsored schemes are limited to hospital services. Given India’s high rates of maternal and child illness and the significant burden of infectious disease, it is important that expanded government purchasing focus on primary and outpatient services.

The Modi government is at a crossroads. Either it can endorse a bold structural shift towards a purchaser-provider split or it can stay with the largely failing status quo by making modest supply-side adjustments. We would encourage the former. The time to act is now.