The Psychology of Secondary Reinforcement

The Psychology of Secondary Reinforcement Theories Behavioral Psychology Print The Psychology of Secondary Reinforcement By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial policy Kendra Cherry Updated on January 19, 2020  Michael H/Getty Images More in Theories Behavioral Psychology Cognitive Psychology Developmental Psychology Personality Psychology Social Psychology Biological Psychology Psychosocial Psychology Secondary reinforcement refers to a situation in which a stimulus reinforces a behavior after it has been associated with a primary reinforcer. For example: When you give your dog a food treat and tell him good boy, hes getting both the primary stimulus of the treat and the secondary reinforcement of the verbal praise. While the primary reinforcers are biological in nature, secondary reinforcers require association with these innate reinforcers before they can produce a response. So, your dog may not associate the verbal praise with a reward unless you combine it with the food treat. Reinforcement and Operant Conditioning? By rewarding certain behaviors, were encouraging the behaviors in the future.?? However, not all reinforcers are the same. Some can be more motivating than others. The dog from our earlier example is more likely to be highly motivated by a primary reinforcer like a treat than a pat on the head ?because food satisfies a strong biological need. If the dogs trainer wanted to pair that food with some type of secondary reinforcement such as the sound of a whistle, the sound of the whistle would eventually become associated with the food and serve as a form of secondary reinforcement. Secondary Reinforcement vs. Primary Reinforcements The primary reinforcers?? occur naturally and do not need to be learned. Examples of primary reinforcers include things that satisfy basic survival needs such as water, food, sleep, air, and sex. Money is one example of secondary reinforcement. Money can be used to reinforce behaviors because it can be used to acquire primary reinforcers such as food, clothing, and shelter (among other things). Secondary reinforcement is also known as conditioned reinforcement. More Examples of Secondary Reinforcement Token economies?? are another good example of how secondary reinforcement can be used in operant conditioning. Token economies involve rewarding people with tokens, chips or stars for good behaviors. These token can then be exchanged for other items that the individual desires. Parents, teachers, and therapists frequently utilize this type of reinforcement to encourage children and clients to engage in adaptive behaviors. While they have no inherent reinforcement value in and of themselves, such tokens can be used to purchase primary reinforcers such as soda pops, candy, and other privileges. Once this association has been made, the tokens themselves become reinforcing. Advantages of Secondary Reinforcement So, what are the advantages of using secondary reinforcement? Why not just skip the trouble of forming an association and simply use primary reinforcement instead? As you can probably already imagine, primary reinforcers are only reinforcing if the subject is in a state of deprivation. A dog is unlikely to perform tricks in exchange for a treat if the animal is full and satiated. A child is unlikely to clean her room to receive a treat if she just finished eating lunch. Utilizing secondary reinforcement allows the trainer to continue to deliver reinforcement even if the subject does not have any biological needs at the moment. This form of reinforcement is less susceptible to satiation, so it provides the opportunity to deliver reinforcement at any time. What Is Reinforcement and How Is It Used in Psychology?

Retail Marketing Management Questions - Free Essay Example

Retail Marketing Management Questions Select a retail sector with which you are familiar. What is the likely impact on the sector of a downturn in the growth of consumer spending- What strategies should a (named) retailer in the sector adopt to minimise the threat? Following the financial and economic crisis in 2007, the reduction in consumer spending had a significant impact upon major high street fashion brands including Marks and Spencer, which saw sales and profitability fall significantly. In response to this, MS adopted a strategy of contraction, which entailed the closure of a number of stores, particularly in the Simply Foods outlet sector. However, despite the fact that this ostensibly led to a reduction of costs, it can be argued that this approach also had an adverse effect upon the marketing mix and competitive advantage of the business. This was proven by the fact that MS lost market share as a result of this strategy while other fashion stores, such as Primark and Zara maintained their growth pat tern through this period. It is considered that the strategy MS should have adopted should have been based upon a more proactive approach. In this respect, there are two elements that the corporation needed to address. The first of these is to ensure that a policy of value chain management is re-enforced, which would reduce costs and therefore prices, while at the same time allowing the business to maintain its profitability levels. For example, had the marketing message for MS been more focused upon delivering consumer savings rather than news of store closures, which forces additional cost on the consumer in terms of travelling to the store, it is likely that consumer loyalty would have been maintained at a higher level. Secondly, there was a need to ensure, through appropriate marketing research, that the products being offered met with the changing demands and needs of the consumer during this period. Similarly, it is likely that had the marketing focus for the business during this period been more directed towards lower cost elements and savings available to the consumer that this would have also contributed in maintaining its market share within the fashion sector. In other words, the corporation needed to adopt a proactive rather than reactive approach to marketing during the economic downturn. There is strong movement amongst supermarkets to buy in consumer products which are not traditional supermarket lines (e.g., TV sets). The supermarkets do not carry a full range of these items and are not committed to carrying them all the time. What are the strategic reasons for this kind of activity? What are the risks? Over recent decades, Supermarkets in the UK have continued to diversify the range and scope of the products and services they offer to their customers. This has included an expansion into non-food products, such as technology and entertainment goods, home furnishings and even the inclusion of service based products, such as banking and insurance offerings. The strategic reason for this diversification has been driven by two factors. Firstly, there is the limitation being placed upon these corporations through competition legislation. For example, when Morrisons recently purchased the Safeway chain, the competition regulator imposed a condition requiring the supermarket to invest in some of the stores in order to maintain the competitive equilibrium in the sector. The second factor that encouraged the incursion of supermarkets into new sectors is the fact that the UK retail grocery sector has reached saturation point within the industry life cycle. This means that further growth can only be achieved at the expense of other competitors. This tends to lead to the development of a more aggressive and retaliatory form of marketing, which can be damaging to the brand and its market share. However, the development of a diversity strategy can attract risks for the brand and its management. In partic ular, these risks occur in two instances. Firstly, the business will be competing with dedicated competitors in the new sector, who are likely to have more expertise and knowledge about the targeted market, and are therefore able to provide effective competitive barriers to new entrants. Secondly, there is the need for the supermarket to allocate significant resources and capital to the new product or service sector. This resource allocation can have the effect of reducing those available to maintain its core business, in this case the grocery sector, which can result in the business losing share to other competing corporations. Both of these factors can reduce the profitability of the corporation, which can adversely affect the ‘added-value it returns to shareholders. It is therefore important for the supermarket to conduct a full assessment of the internal and external business environment before considering such diversification. Evaluate the benefits of ECR (Effic ient Consumer Response) for retailers? Do you think the benefits are sufficient to ensure co-operation between suppliers and retailers? Your answer should be applied to a retail sector of your choice. Efficient Customer Response (ECR) is a relatively new supply chain process, which is designed to ensure to eliminate the efficiencies that have previously been experienced within the supply chain. For example, the objective is to eliminate inventory wastage and, as a consequence, ensure that the products delivered to the end user satisfies their needs and demands. For example, in the retail fashion sector, ECR would be used not only to ascertain which products are proving most popular with the consumer but also to ensure that the quantity of supply, in terms of sizes etc, is being met. One of the most innovative methods of ECR within the retail sector has resulted from RFID technology, a process that Marks and Spencer has rolled out through most of its UK stores. The benefit of this system is that it allows the corporations direct access to stock movements on the retail floor. For example, a footwear supplier to MS using this system is not only able to monitor in-store inventory levels in specific locations but also identify those sizes that are proving to be most popular with consumers in this location. The immediacy of the access to this information allows the supplier to both adjust future production schedules to meet the size determinants demanded by consumers and ensure that differentials in location demands are factored into the distribution network. For MS, the introduction of the RFID has had several benefits. These include a reduction in the cost of storage and wastage and an improvement in the level of satisfaction and quality of service provided to its customers. Both of these improvements have also service to reduce the level of capital required to service the corporations inventory requirements and improve its brand image, which has resulted in an increase in profitability for the corporation. For a retailer with which you are familiar explain how the image of the company is related to its positioning and how this is reflected in the management of the retail mix. Is the company managing these elements well? The objective of brand image is to achieve the objective of firmly position the organisation as a leading competitor within the target market in a manner that will attract consumers in this segment. Within the retail sector, this means that the corporation needs to pay attention to what has become commonly known as the 7rs, which include the following: Product offering Service offering Retail pricing Location Visual atmosphere Localised marketing Quality of customer service It is the effective management of this mix that will determine both the effectiveness of the brands management and impact upon its competitive advantage within its chosen market sectors. Marks and Spe ncer Plc is a UK high street retailer which focuses upon three main retailing sectors, these being quality fashion, foods and home-ware products. In the early 2000s, prior to the abortive takeover attempt by Philip Green, it was noted that MS were experiencing failings in several areas of the retailing mix. For example, in terms of the fashion product offering, the corporations products were failing to delivery new and innovative designs that were aimed at satisfying the needs and expectation of the target consumers, particularly those within the younger target audience. Consequently, the corporations market share in this area was rapidly been lost to new and innovative brands such as Next and Gap. Similarly, in both its fashion and food products it was failing to deliver to consumer expectations for quality at the right price, thereby failing to address the inroads that other retailers, particular the low-price supermarkets and fashion retailers were making into these sectors . Furthermore, the location and atmosphere of the MS stores were also causing a problem. In this respect, it was considered the brand image had become tired and uninviting. This situation was not helped by the adverse impact of the failures in the corporate strategy was having on employees, which meant that the quality of customer service was also was also reducing. It took a change of management in 2004 to address these retail mix problems and revive the MS fortunes in a positive manner, as evidenced by the fact that in 2008 it returned its first  £billion profit since 1998. How can service enhance the management of the retail mix? Illustrate your answer with examples from retailers with which you are familiar. In retailing, service is perhaps the most important factor in determining the success or failure of a brand. In this respect, the term services applies to both the quality of the product in terms of the extent to which is satisfies consumer demands and expecta tion and the quality of service that is provided by the retailers employees, particularly those on the front line, namely those who have direct contact with the customer. Failures in these areas of the retail mix will result in the loss of the retailers competitive advantage and, more importantly, the migration of its core consumer base to other retailers within the same retail market sector. In the early part of the last decade (2000s), Marks and Spencer, one of the most renowned UK high street retailers, was suffering from service failure in both of the areas described. Its products, particularly those in the fashion sector, were failing to meet with the changing demands of the consumer. In other words, it was failing to deliver new fashion products that would appeal to the consumers at a price that was expected. Similarly, due to a lack of investment in human resource programmes and initiatives, the standard of quality service delivered to the customer by employees was b ecoming a deterrent to customer loyalty. Following a change of management in 2004, MS reinvented its brand image. This was noticeable in its marketing campaigns which, from the fashion aspect, introduced a new range of innovative and exciting products aimed at a wider target audience in terms of age, using celebrities such as Twiggy to enhance its appeal. The ‘Your MS slogan was also extended to the MS food sector, which has resulted in improvements in the market share attracted to this target segment of the corporations consumers. Similarly, investment in HR policies that have increased employee involvement has also resulted in a noticeable improvement in the quality of service being delivered in-store to the customer. Recommend an internet strategy for a retailer with which you are familiar. Indicate how this strategy fits with their mainstream strategy With online retailing in the UK expected to double within the next five years , it is not surprising to find that the four main brands in the UK grocery sector, Tesco, Asda, Sainsbury and Morrison, have sought to expand their brand presence within this medium in a manner that augments their mainstream marketing approach through the TV and print media. To compete successfully with these low-cost brands, this means smaller competitors such as Waitrose, have to fully suit . In essence, to achieve this competitive position and maximise its growth potential in this media, Waitrose would need to adopt a multichannel online strategy. In addition to a corporate website, which Waitrose has already developed, this means that Waitrose needs also to develop other online marketing channels through which to communicate their message to the online retail consumer. These will include the use of social networks, where the business will be able to communicate directly with consumers and address their concerns and also the direct online promotional opportunities available, such as banner and displa y advertising available on search engines and other internet sites. Providing the online marketing strategy adopted by Waitrose presents the same characteristics as its in-store experience, this approach will enhance and complement its offline strategy. In this respect, in terms of the website it means that there should be ease of access and navigation , security of payment, sufficient depth in the range of products being offered and a high level of quality service being offered to the consumer. If these issues are appropriately addressed then it will result not only in attracting and retaining online customers, with the resultant increase of revenue generated from this source, but will also improve awareness of the brand when the online consumer is making purchasing decisions in the high street retailing environment. In other words, it is apparent that both the online and offline strategy would complement each other and result in improved the performance of the Waitrose br and as well as the loyalty of the consumer. References You can get expert help with your essays right now. Find out more Arnold D (1992). The Handbook of Brand Management. London: The Economist Books Hall (2010), Online food shopping expected to double in five years, London: Daily Telegraph Johnson, G, Scholes, K and Whittington, R (2007), Exploring Corporate Strategy, 8th Edition. Harlow: FT Prentice Hall Keller, K.L. Lehmann, D.R. (2006) Brands and branding: Research findings and future priorities. Marketing Science. Vol. 25, No. 6, pp. 740-759 Kolter, P., Wong, V., Saunders J and Armstrong, Gary (2004). Principles of Marketing. 4th European edition, London: Pearson Education Ltd Levy, M and Weitz, B.A (2008), Retailing Management, 7th Edition, Chicago: McGraw Hill Porter, Michael E (2004). Competitive Strategy: Techniques for Analysing Industries and Competitors. New York: Free Press Porter, Michael E., (2001). Strategy and the Internet, Harvard Bus iness Review, March, pp. 63-78. Srinivasan, R., Rangaswamy, A and Lilien, G (2005). Turning adversity into advantage: Does proactive marketing during a recession pay off? International Journal of Research in Marketing, Vol.22, Issue. 2, pp.109-125 Find out more from UK Essays here: https://www.ukessays.com/services/example-essays/marketing/retail-marketing-management.php#ixzz3EEceeXKm

The Latino / A Community - 927 Words

Individual Reflection For our group project, the five of us worked together to understand and analyze the Latino/a community which exists within the West Colfax neighborhood in Denver, Colorado. In order to conduct this analysis and create our recommendations, we came together as an organization and sought to understand the Latino/a culture through a community practice lens. To understand our organization, I will reflect upon our work through a critical theory for community change lens to help understand how we approached our work, a group story-telling modality to create an idea of the type of change we would seek to effect with our information, and a power cube analysis to understand the dynamics of power within our organization. According to Hardcastle and Powers (2004); â€Å"Critical theory focuses on dominating institutions and how the system works, on large-scale capitalistic structures and how they intersect with local environments† (pg. 47). As our group began to gath er information about the Latino/a community at West Colfax, we began to hone in on two aspects of this community: gentrification and socioeconomic status. Gentrification occurs as capitalism spreads and begins to dominate lower income neighborhoods; as high income businesses, housing developments, and investments are poured into a lower income neighborhood, the lower socioeconomic status residents are forced out, unable to keep up with the capitalist growth. As we learned in our research, many of theShow MoreRelatedThe Latino And Latino Community1610 Words   |  7 PagesThe Hispanic/Latino community has been known to be underrepresented on college campuses, both at the community college and four-year university level. Factors such as low-income households, poor or harsh living conditions, under-educated parents, cultural and family commitments, and unfamiliarity with the college process, all serve as unfortunate barriers that keep Hispanic/Latino students from reaching the goal o f attaining college degrees. Although these barriers keep many students from succeedingRead MoreDiabetes in the Latino Community1648 Words   |  7 PagesIntroduction Diabetes is a prevalent health disparity among the Latino population. Diabetes is listed as the fifth leading cause of death among the Latino population in the website for Center for Disease Control and Prevention, CDC, in 2009. 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Recent programs such as public service announcement and sexRead MoreEffects Of Dropout Rates On The Latino Communities Essay1024 Words   |  5 PagesThe Latino population is increasing and data shows that there is a vast majority of students who are dropping out of school. Dropout rates is a great concern to school districts and to the U.S. in general. If the population is increasing this means that our future generation need to be well equipped to help us progress. There are several studies and research that discuss the different factors that contribute to dropout rates in the Latino communities. As we look over previous literature and studiesRead MoreEmergency And Disaster Preparedness Education For The Latino Community3065 Words   |  13 Pages Emergency and Disaster Preparedness Education for the Latino Community Rachael P. Donnelly Joyce K. 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Humanitarian intervention Free Essay Example, 2500 words

Humanitarian intervention is the exercise of military force in another state’s territory to give humanitarian support to the people of that country. Usually, the necessity of humanitarian support is brought about by the existence of several human rights violations. Humanitarian intervention is a process of implementing human rights and is generally rationalised on such bases (Krieg, 2012). The universal nature of human rights offers the foundation of such rationale. The defence of intervention through reference to universal human rights creates several issues. The usual theoretical basis for defending the international community’s exercise of military violence is ‘just war theory’, and this is derived from the primacy of national sovereignty. However, humanitarian intervention frequently disrupts national sovereignty (Kassner, 2013). It is a fact that the area of just war theory regarding how violence or force could be exercised—jus in bello (the la w in waging war)—is aware of human rights, as shown, for instance, in the code of discrimination. However, the just war principles of jus ad bellum (right to war), which refer to the exercise of military force across territories largely consider national defence as an important requirement for such reasoning (Carlsnaes, Risse & Simmons, 2012). We will write a custom essay sample on Humanitarian intervention or any topic specifically for you Only $17.96 $11.86/pageorder now Force can reasonably be exercised only in reaction to hostility by another state. On the contrary, the violations of human rights that validate humanitarian intervention take place within a state. It is the state which perpetrates hostility against its own people but not against another state (Carlsnaes et al. , 2012). Such conflict between humanitarian intervention and national sovereignty underlines a core dilemma with just war theory that was already obvious in the past. The theory must concern the attainment of justice and, otherwise, must not be pursued. Justice involves protection of human rights (Hehir, 2013). Conventional principles of jus ad bellum, which stress the primacy of national sovereignty, appear to hinder the attainment of justice with regard to violations of human rights that take place within states. This opposition is usually conveyed by arguing that jus ad bellum has an undesirable statist focus. It views states as the essential moral actors and beneficiaries. It is the rights of the state that are encroached upon when hostility takes place, and, based on conventional just war theory, merely this kind of violation can rationalise the exercise of force across borders (Pattison, 2010).

Religious Autobiography - 815 Words

Religion 100, Paper #1, Who I have become today We may all be different people, but we each have a religion we belong to which describes who we are and who we will become. My name is Maritza Lopez-Portillo and I will be telling you my personal experience and what brought me to where I am now due to my religion. Throughout my life I have always been a Catholic, but never took much meaning of it into my life, till I was in my junior year of high school. Growing up I was always a Catholic and I would attend mass with both my parents, as well as being put into Catechism classes for my First Communion. At that point of my life I was still young; I was in second grade. I did not pay much attention in class and the value of my religion did†¦show more content†¦I really think that because I have gone in the right direction with Him, I have had many amazing things happen, from family being all employed to me getting scholarship to North Dakota State. Through Him I know all things are possible, and when things start to go wrong, I will keep my faith in him. I hope through my personal experience I have written about you have caught a glimpse of who I have become and what my religion means toShow MoreRelatedAnalysis Of The Article Of Margery Kempe 1216 Words   |  5 Pagesappearance and body based on Margery’s attire. Reduction to Body, â€Å"the treatment of a person as identified with their body, or body parts† (feminist perspectives on objectification), can be seen throughout Medieval England and Margery Kempe’s autobiography. The female body especially, has undergone immense scrutiny for simply existing, genitelia often referred to as â€Å"shamefuls†(Allen 191). 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I Am A Friend Of Mine Caused Me Essay - 1839 Words

I didn’t bother to wonder what education means to me until I was about to attend college. A friend of mine caused me to. Now I feel thankful to have him as my friend because the lesson I learned from that wondering is priceless. My story started on a Saturday afternoon as I recall. I was in tenth grade at the time. I told my mother that I was going to visit my friends. I promised to my mother that I would get all my assignments done by next week. But I lied to her. I used to work on my assignments when the deadlines were close. Fortunately, my mother believed me. I bicycled to visit one of my closest friends. His name is Phap. He is a kind and bulky guy. I, Phap and another guy named Hai are very close. When I reached his place, I stood out of the gate. I did so because I was afraid of dog and Phap raised two â€Å"unpleasant† dogs. I shouted to call him out instead of coming in. He took me in and settled down for a while before we headed our way to visit Hai. Hai lives pretty far from both of us so anytime he wants to visit us back, he rides his motorcycle that his father allows him to. I and Phap rode our own bicycle to his place. The weather was inconvenient since May was coming. We both reached his place with our shirt filled with sweat. Hai invited us into the house and set us down with a jar of iced water. We greeted each other and carried on discussing what we were expected to do. We promised the previous day that we would come and help him with his preparation for theShow MoreRelatedMy Habit Of Lips Licking And Biting900 Words   |  4 PagesThe behavior I want to eliminate in this assignment is my habit of lips licking and biting. When I heard about this assignment, I started to search for a bad habit. After a few days of observation, I found that I bite my lips a lot and also I lick my lips. Especially, while I am in a boring class or when I am in boring situations. 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Health Issues of a Developed Country (The US) Free Essays

string(167) " government proposed some fundamental structural and functional reforms to the NHS that are listed in the white paper ‘Equity and Excellence: Liberating the NHS’\." Abstract Since 1948 the NHS has undergone significant changes in its structure and mode of operation. There is a distinct shift as witnessed by a change from the fully public model of care delivery towards increasing private participation in the NHS system. The increasing health care consumption and cost pressures have, to an extent, compromised on the original 1948 manifesto of totally free health care access to all. We will write a custom essay sample on Health Issues of a Developed Country (The US) or any similar topic only for you Order Now While the restructuring of the NHS listed in the white paper ‘Equity and Excellence: Liberating the NHS’ is in response to changing demands, care should be taken in the form of having enough performance monitoring and quality checkpoints that ensure that private participation does not erode some of the fundamental strengths and qualities of the NHS, the most basic of which is to enable equity of access to quality healthcare. Introduction The NHS was launched on July 5th 1948 by the then health secretary Mr. Aneurin Bevan with a view to provide healthcare for all based on citizenship and need and not based on the ability to pay. It was fully funded by taxation. The NHS therefore became the central umbrella organization that provided all medical and related services free at the point of access to all UK citizens (NHS, 2011). Since its inception the NHS has transformed significantly and today it has become the world’s largest publicly funded healthcare system (NHS, 2013). The NHS employs more than 1.5 million people (White, 2010, pg 3). Though the original manifesto of the NHS was to provide quality medical care for all those in need irrespective of their ability to pay, the NHS has underwent a series of changes and reforms over the last several decades. The aging society, increasing health care demands, and the financial pressures it creates on the healthcare system have in effect necessitated some significant r eforms in the way the NHS operates. This paper will discuss these changes in structure and functional aspects of the NHS as highlighted in the white paper ‘Equity and Excellence: Liberating the NHS’ (DH, 2010) and some fundamental reforms in context of the passing of the Health and social care bill 2011. In the first 25 years from 1948 there was a clear distinction in that community health services were managed separately by the local authorities while hospitals were managed by the NHS. Some structural changes in the NHS were bought about in 1974 and since then both community health services and hospitals have together come under the purview of the NHS (Webb, 2002, pg 4). Under the original 1948 manifesto cost was not a factor and doctors were advised to provide the best care for the patient without any cost considerations (Leathard, 2000). Growing medical bills and budgetary deficits have constrained the government in fully implementing their primary manifesto of providing free treatment at the point of access, and gradually since 1951 charges were introduced for dentures and spectacles (Leathard, 2000, pg 34). Similarly since 1952, prescription costs were introduced. Over the years prescription charges have witnessed an incremental increase and as of April 2012 prescription charges are at 7.65 (Politics .co.uk, 2012). Widespread protests against the prescription charges have contributed to several exceptions in the prescription drug charges including for children under 16, pregnant women, elderly people above 60, etc. More recently people with chronic conditions such as cancer have been included into those under the exempted category. While in Wales and Northern Ireland prescription charges have been completely abolished, the English government has, however, indicated that no further free prescription programs would be introduced but that the new policies would focus on brining more fairness into the prescription charging system (Politics.co.uk, 2012). Transition to a Market System Chronic underfunding and gaps in services and the pressures to improve the overall operating efficiency have gradually led to the NHS from being a total public ownership entity towards a market based system. In fact this shift towards a market based system could be traced way back to the Thatcher administration that introduced the policies of ‘general management’ and ‘outsourcing’ which bought about a fundamental shift. General managers were people who were specialized in hospital management and provided a neat layer of interfacing between the health policy makers and the doctors and nurses who implement the policies. Outsourcing of non medical services such as hospital cleaning, catering saw for the first time the entry of the private sector into the NHS system (DH, 2005). Since then private sector participation in the NHS has improved significantly. By the late 1990’s, for instance, long term care by NHS was already taken over to a large extent and managed by private for profit service providers. Long term elderly care is no longer free of cost. Increasing private participation could be inferred from the statistics that from over 137,200 residential care homes in 1985 the numbers had dropped to 64,100 by 1998 (BBC, 1999). Elderly care in these settings is not free and is totally means based with those earning more than ?16,000 per annum having to bear the entire expenses while the state provides maximum assistance for those under ?10,000 categories. NHS Spendings review points out that between 1998 and 2010 there was an average 5.75% increase in health expenditure while the NHS is slated to receive .4% real terms growth between 2010 and 2014. This indicates the degree of financial pressure under which the NHS is operating. As (Appleby et al, 2009) points out, the pressure on NHS will continue to increase with growing challenges due to a mixture of factors including an aging demography, high cost pressure of new medical technologies, and the expectation for higher quality standards. It is estimated that the NHS has to make considerable cost cuttings by way of improved operational efficiency to the tune of ?15 to ?20 billion in order for it to be able to continue providing equitable access to healthcare services to all the citizens(Nicholson, 2009). It is under these dire circumstances that the UK government proposed some fundamental structural and functional reforms to the NHS that are listed in the white paper ‘Equity a nd Excellence: Liberating the NHS’. You read "Health Issues of a Developed Country (The US)" in category "Essay examples" One of the fundamental changes to the organization of the NHS as listed out in the White paper is the devolution of the ‘Primary care Trusts’ (PCTs) (Nuffield Trust, 2010). The PCTs which were instituted in 2002 to supervise primary care provision is no longer a valid entity. Its function has been taken over by Clinical commissioning groups (CCG) comprising mainly of local GPs. The idea behind such a reform is to increase local empowerment. Furthermore the PCTs were in the past struggling with frequent restructuring. One of the underlying motives behind such a transformation is to place greater responsibility with the local GPs as they are directly involved in service referrals. Also since GPs are directly involved in both commissioning and care provision they are better positioned to make effective assessments and to prevent unnecessary hospitalization and other services. In other words, the establishment of the GP consortia which is one of the highlights of the ‘ Equity and Excellence: Liberating the NHS’ white paper, is expected to increase the integration between the GP’s , specialists and other service providers paving way for an integrated care delivery mechanism that is both cost effective and efficient. Furthermore, the white paper also refers to the formation of a NHS commissioning board that supervises the overall equitable access to NHS services, commissioning, and the proper allotment of resources. This would ensure that micromanagement is not an issue at the NHS. The new policy framework also dissolves several quangos thereby resulting in greater operational savings. By these means the new reforms are slated to save up to 20 billion in terms of efficiency of operations by 2014. Projections indicate that up to 45% savings could be realized in the form of management related cost savings (DH, 2010, pg 5). One of the distinctive factors of the current NHS reforms compared to the original NHS policies is the shift from a purely public system towards a more market centric healthcare system. The focus on increasing the participation of the patient and providing them the choice as to their service providers and the treatment that they want are particularly prominent aspects of the new healthcare bill. . The inclusion of the ‘choice of any willing provider’ in the ‘Health and Social Care Bill’ lays stress on the increased freedom for the health consumer (DH, 2010, pg 17). It also emphasizes the increasing competition among contracted health service providers which is ultimately good for improving the overall quality of health care delivery. Reduction in bureaucratic control and empowerment of the care providers imply that the primary care providers’ could function independently and effectively to meet the needs of the patients. Effective monitoring is the key to any functional system. For a huge organization such as the NHS monitoring the functioning of the various agencies and systems is very vital for achieving streamlining of operations, process efficiency and achieving high quality of care. One of the key aspects of the new reforms is entrusting local health watch organizations with the responsibility of managing and addressing the feedbacks from the health consumers. These organizations also support the patients in making their decisions about service providers. These organizations will directly report the performance measures of service providers and patient feedbacks to local as well as national authorities helping to address any consumer grievances and quality concerns at the earliest(DH, 2010, pg 19). While there are proponents for this new system there are also concerns expressed by politicians, professionals and general public who are worried that the competition between medical service providers would engender compromise on quality of services contrary to improving the same. This is particularly so when these decisions are made on the bidding approach and when lower cost of service provision is the main criteria. One particular instance is the drug and alcohol support services that are vastly privatized in the UK. These private organizations are paid ?3000 if the addicts are rehabilitated and remain free of drugs for 3 months and a further ?5000 if they remained drug free for a whole year. There are complaints that under these circumstances, in these private organizations, the focus is not entirely on rehabilitation and saving the patient is not the primary concern. As a case in point, an extreme heroin addict was just discharged from the clinic without any alternative interven tion. Methadone prescription for detoxification was not even tried as the private company would not be remunerated for such an intervention (Pemberton, 2013). . Furthermore since the entire drug and alcohol services is taken up by the private organizations there was no further referral or intervention possible for such cases. These are instances that point out the risks in adapting a privatized and highly fragmented setup. Furthermore there are concerns that under the concept of ‘payment by results’ that is advocated under the new NHS policies, there is even more risk that the private agencies would just focus on achieving end points of care. While this approach would be okay for acute clinical conditions it leaves a lot to be desired in the management of chronic conditions where there is no visible endpoint. Conclusion From the time of its institution in 1948 to the current period, the NHS has undergone significant changes in its mode of operation. Presently, there is a distinct shift in healthcare focus as witnessed by a change from the fully public model of care delivery towards increasing private participation in the NHS system. Growing elderly population and increasing strain on its health services have forced the NHS to adopt these new and novel approaches. These include a fundamental change in its mode of care delivery with the increasing private sector participation in care delivery. Though maintaining free point of access care delivery is one of the main mottos of the original 1948 NHS manifesto, the increasing health care consumption and cost pressures have, to an extent, compromised on this objective. Today many services such as prescription drugs, long-term care are no longer free and there is increasing private sector participation as contracted service providers. The purely fragmented approach of private sector service providers who are driven by a contractual obligation and cost centered focus, would definitely compromise the quality of services and the original advantages that the NHS offered. While the growing needs and the changing demands have necessitated such drastic transformation of the NHS system, care should be taken in the form of having enough performance monitoring and quality checkpoints in place that ensure that private participation does not erode some of the fundamental strengths and qualities of the NHS, the most basic of which is to enable equity of access to quality healthcare. Bibliography Appleby J, Crawford R and Emmerson C (2009) How Cold Will it BeProspects for NHS Funding 2011–2017. The King’s Fund. Audrey Leathard, (2000), Health Care provision: Past, present and into the 21st century, Second Edition, Published by Nelson Thornes Ltd. UK. BBC (1999), What is Long-Term careViewed June 25th 2013, CDC (2012), Overweight and Obesity : Adult Obesity Facts, viewed June 25th 2013, http://www.cdc.gov/obesity/data/adult.html CDC (2012), Alcohol and Public Health : Fact Sheets Binge Drinking, viewed June 25th 2013, http://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm Dinesh C Sharma (2010), India’s No 1 Killer: Heart Disease, viewed June 25th 2013, http://indiatoday.intoday.in/story/India’s+no.1+killer:+Heart+disease/1/92422.html DH (2005), The NHS Plan: a plan for investment and reform, CM 4818-I, The Stationery Office, Annual Report 2005, p. 55 DH (2010), Equity and excellence: Liberating the NHS, viewed June 25th 2013, ISRO (2005), Telemedicine: Enabling specialty healthcare to the rural and remote population of India, viewed June 25th 2013, http://www.isro.org/publications/pdf/Telemedicine.pdf Katherine A Webb (2002), From County Hospital to NHS Trust: Volume 1: History, University of York. Max Pemberton (2013), NHS reforms: From today the coalition has put the NHS up for grabs, viewed June 25th 2013, Politics.co.uk (2012), NHS Prescription charges, viewed June 25th 2013, http://www.politics.co.uk/reference/nhs-prescription-charges NHS (2011), NHS History, viewed June 25th 2013, NHS (2013), The NHS in England, viewed June 27th 2013, Nicholson D (2009) The Year 2008/09. Department of Health, viewed June 25th 2013, Nuffield Trust (2010), NHS resources and reform: Response to the White paper equity and excellence: Liberating the NHS, and the 2010 Spending Review, viewed June 25th 2013, Tony White (2010), A Guide to the NHS, Radcliffe Publishing Ltd. The Economic Times (2013), India probably world’s third largest economy: OECD, viewed june 25th 2013, http://articles.economictimes.indiatimes.com/2013-05-30/news/39603030_1_gdp-growth-third-largest-economy-economic-growth-projection Victoria Barbary (2007), Primary Care Trusts: Tailoring Commissioning, NLGN White Paper, Viewed June 25th 2013, How to cite Health Issues of a Developed Country (The US), Essay examples