Term Paper Guidelines 1.     Identify a Health, Human or Ecological Topic for Analysis. 2.     Describe the topic and how it relates to the Course, Course Concepts and/or principles. 3.     Analyze the Decision-Making Process (Human) or the Environmental (Ecological) application that is used for your topic     4.     What is the reason for your interest or analysis? 5.     What changes or recommendations should be made? 6.     Would you try to influence your area of interest? Why or why not? How? Note: The 6-8 page paper must be typed (12-14 point font), with separate reference (scholarly using MLA, APA or Scientific) and title page. Thoughts: 1) Term Paper for Health; Water or Air Quality(Indoor), Asthma, Food Safety, Nutrition , GMO’s vs Organic, Obesity, Drugs and addictions 2) Term Paper for Human Ecology; Poverty, Housing, Wastes, Sanitation, Food Security and, Human Hazards (Radiation, and Pesticides); or School Dropouts, Juvenile delinquency and Crime 3) Natural Hazards (Fire, Flood, Freezing, Earthquakes), and Disease epidemiology (Ebola, malaria etc.) 4) Science information/data/research can be used for advocacy of a special interest group, showing differences of expert s, contrasting positions and taking-sides or showing the trade-offs. How are Impacts or hazards measured or assessed? i.e. cost-benefit analysis, risk assessment, or health/ecological thresholds/indicators. What are the time frames for decisions? Emergency, Law Enforcement procedures, planning process Is there an environmental health strategy; Health Education/Promotion, Design with Nature, pollution prevention, or environmental enhancement. Booklist 1. The Worst Hard Time: The Untold Story of Those Who Survived the Great American Dust Bowl –Timothy Egan 2. A Fine Balance by Rohinton Mistry (India Sterilization-Chapter 2) 3. The Omnivore’s Dilemma by Micheal Pollan (Meat Industry) 4. In Defense of Food by Micheal Pollan (Corn Syrup) 5. The Blue Zones: Lessons for Living Longer From the People Who've Lived the Longest by Dan Buettner 6. The Good Gut: Taking Control of Your Weight, Your Mood, and Your Long-term Health by Drs. Justin Sonnenburg and Erica Sonnenburg (Health) 7. Grain Brain by Dr. David Perlmutter 8. Twelve Diseases that Changed the World by Irwin Sherman 9. Collapse: How Societies Choose to Fail or Succeed by Jared Diamond (Civilizations) 10. Guns, Germs, and Steel: The Fates of Human Societies by Jared Diamond 11. Brain Rules by John Medina (Healthy Brain) 12. The Shallow: What the Internet Is Doing to Our Brains by Nicholas Carr (Internet reworking our brains) 13. Climate Change: The Facts by Alan Moran and etc. (Not man-made) 14. I Eat: Around the World in 80 Diets by Peter Menzel, Faith D'Aluisio 15. Hungry Planet: What the World Eats by Peter Menzel, Faith D'Aluisio 16. This Changes Everything: Capitalism vs. The Climate by Naomi Klein 17. The Glass Castle: A Memoir by Jeannette Walls (Homelessness) 18. The Ghos.

1. Term Paper
Guidelines
1. Identify a Health, Human or Ecological Topic for
Analysis.
2. Describe the topic and how it relates to the Course, Course
Concepts and/or principles.
3. Analyze the Decision-Making Process (Human) or the
Environmental (Ecological) application that is used for your
topic
4. What is the reason for your interest or analysis?
5. What changes or recommendations should be made?
6. Would you try to influence your area of interest?
Why or why not? How?
Note: The 6-8 page paper must be typed (12-14 point font), with
separate reference (scholarly using MLA, APA or Scientific)
and title page.
Thoughts:
1) Term Paper for Health; Water or Air Quality(Indoor),
Asthma, Food Safety, Nutrition , GMO’s vs Organic, Obesity,

2. Drugs and addictions
2) Term Paper for Human Ecology; Poverty, Housing, Wastes,
Sanitation, Food Security and, Human Hazards (Radiation, and
Pesticides); or School Dropouts, Juvenile delinquency and
Crime
3) Natural Hazards (Fire, Flood, Freezing, Earthquakes), and
Disease epidemiology (Ebola, malaria etc.)
4) Science information/data/research can be used for advocacy
of a special interest group, showing differences of expert s,
contrasting positions and taking-sides or showing the trade-offs.
How are Impacts or hazards measured or assessed? i.e. cost-
benefit analysis, risk assessment, or health/ecological
thresholds/indicators.
What are the time frames for decisions? Emergency, Law
Enforcement procedures, planning process
Is there an environmental health strategy; Health
Education/Promotion, Design with Nature, pollution prevention,
or environmental enhancement.
Booklist
1. The Worst Hard Time: The Untold Story of Those Who
Survived the Great American Dust Bowl –Timothy Egan
2. A Fine Balance by Rohinton Mistry (India Sterilization-
Chapter 2)
3. The Omnivore’s Dilemma by Micheal Pollan (Meat Industry)
4. In Defense of Food by Micheal Pollan (Corn Syrup)
5. The Blue Zones: Lessons for Living Longer From the People

3. Who've Lived the Longest by Dan Buettner
6. The Good Gut: Taking Control of Your Weight, Your Mood,
and Your Long-term Health by Drs. Justin Sonnenburg and
Erica Sonnenburg (Health)
7. Grain Brain by Dr. David Perlmutter
8. Twelve Diseases that Changed the World by Irwin Sherman
9. Collapse: How Societies Choose to Fail or Succeed by Jared
Diamond (Civilizations)
10. Guns, Germs, and Steel: The Fates of Human Societies by
Jared Diamond
11. Brain Rules by John Medina (Healthy Brain)
12. The Shallow: What the Internet Is Doing to Our Brains by
Nicholas Carr
(Internet reworking our brains)
13. Climate Change: The Facts by Alan Moran and etc. (Not
man-made)
14. I Eat: Around the World in 80 Diets by Peter Menzel, Faith
D'Aluisio
15. Hungry Planet: What the World Eats by Peter Menzel, Faith
D'Aluisio
16. This Changes Everything: Capitalism vs. The Climate by
Naomi Klein
17. The Glass Castle: A Memoir by Jeannette Walls
(Homelessness)
18. The Ghost Map by Steve Johnson (Cholera in London)
19. How Not to Die by Michael Gregor (Nutritional Foods)
20. A Framework for Understanding Poverty by Ruby Payne

4. 21. Silent Spring by Rachael Carson
22. When Breath becomes Air by Paul Kalanthi
23. FactFulNess by Hans Rosling
Movie List
1. Temple Grandin (Livestock Industry)
2. City of God (Brazil Favellas/Shanty Towns)
3. Darwin’s Dilemma (Invasive Species-Lake Victoria)
4. Forks Over Knives (Documentary)
5. Cosmos (Documentary-Episode “The Clean Room”- Lead in
Gasoline)
6. Philadelphia (AIDS)
7. The Big Short (Housing)
8. The Soloist (Homelessness)
9. Climate Hustle (Documentary)
10. What the Health(Documentary)-Links between diet and
disease
11. What happened to Monday? (Sci-Fi-Pop Control)
12. Soylent Green, (feed people)
13. “Global Waste-Food Waste”-Netflix
14. “A Plastic Ocean” (Documentary)

5. Unit 4 Assignment
Cost Accounting System Paper
Unit outcomes addressed in this Assignment:
· Differentiate among the general types of cost behavior.
· Propose a rationale for cost allocation in healthcare
organizations.
Course outcome addressed in this Assignment:
Assess cost concepts, management control processes of
budgeting, revenue cycle management, working capital, time
value analysis, capital budgeting analysis, and long-term
financing decisions.
PC 6.1: Incorporate data, inferences, and reasoning to solve
problems.
Assignment Instructions
SOONER HEALTH NETWORK (the Network), which consists
of five medical group practices, is a subsidiary of not-for-profit
Sooner Health System (the System). The Network includes both
primary care and specialty physicians, with an emphasis on
obstetrics/gynecology, eldercare, and pediatrics. Prior to the
founding of the Network, the five practices operated
independently.
The Network has three practice locations, each staffed with a
mix of primary care and specialist physicians. Although the
Network itself is only marginally profitable, it is an important
contributor to the profitability of the System because it
generates a large amount of revenues from referrals for both
inpatient admissions and inpatient and outpatient ancillary
services. In fact, each $1 of revenue generated within the
Network is estimated to lead to $8 of inpatient and ancillary
revenues to the System. By limiting the amount of ancillary
services provided at the three Network locations, patients are
forced (or at least encouraged) to use other System facilities for
such services.
Still, some ancillary services are best performed at the Network
locations for one or more of the following reasons: lower costs,

6. increased physician efficiency, and improved patient
convenience and hence better CAHPS (Consumer Assessment of
Healthcare Providers and Systems) scores. For example, one of
the practice locations now has a diagnostic imaging capability.
When the scanner was moved from another facility to the
Network location, volume increased, costs decreased, and both
physician and patient satisfaction improved. (For more
information on the CAHPS program, see www. ahrq .gov/
cahps/ about-cahps/index.html)
The proposal currently being considered by the Network is to
provide ultrasound services at the Network locations.
Preliminary analysis indicates that two approaches are most
suitable.
Alternative 1 involves the purchase of one ultrasound machine
for each of the Network's three locations. Patients would
schedule appointments, generally at the clinic they are using,
during preset times on specified days of the week. Then, the
full-time ultrasound technician would travel from one location
to another to administer the tests as scheduled. Alternative 2, on
the other hand, involves the purchase of only one ultrasound
machine, but patient scheduling would be the same. The
machine would be mounted in a van that the technician would
drive to each of the three Network locations. Most of the
operating costs of the two alternatives are identical, but
Alternative 2 has the added cost of operating the van and setting
up the machine after each move.
The two alternatives differ substantially in capital investment
costs because Alternative 1 requires three ultrasound machines,
at a cost of $100,000 each, whereas Alternative 2 requires only
one machine. However, Alternative 2 requires a van, which
with necessary modifications would cost $40,000. Thus, the
capital costs for Alternative 1 total 3 x $100,000 = $300,000,
whereas the costs for Alternative 2 amount to only $100,000 +
$40,000 = $140,000.
Because the two alternatives have different operating costs, a
proper cost analysis of the two alternatives must include both

7. capital investment and operating costs. The Network financial
staff, which is the System financial staff, considered several
methods for estimating the operating costs of each alternative.
After much discussion, the chief financial officer (CFO)
decided that the activity-based costing (ABC) method would be
best. Furthermore, an ad hoc task force was assigned to perform
the cost analysis.
To begin the ABC analysis, the task force had to develop the
activities involved in the two alternatives. This task was
accomplished by conducting walkthroughs of the entire process
from the standpoint of the patient, the ultrasound technician,
and the billing and collections department. The results are
shown in exhibit 8.1. A review of the activities confirms that all
except one - consisting of transportation, setup, and breakdown
- are applicable to both alternatives.
The next step in the ABC process is to detail the costs
associated with each activity. This step uses financial,
operational, and volume data, along with the appropriate cost
driver for each activity, to estimate resource consumption. Note
that traditional costing, which often focuses on department-
level costs, typically first deals with direct costs then allocates
indirect (overhead) costs proportionally according to a
predetermined allocation rate. In ABC costing, the activities
required to produce some service, including both direct and
indirect, are estimated simultaneously. For example, exhibit 8.1
contains activities that entail direct costs (such as technician
time) and activities that entail indirect costs (such as billing and
collection). Although the ABC method is more complex and
hence costlier than the traditional method, it is the only way to
accurately (more or less) estimate the costs of individual
services.
Activity cost detail on a per procedure basis is contained in
exhibit 8.2. Each activity is assigned a cost driver that is most
highly correlated with the actual utilization of resources. Then,
the number of driver units, along with the cost per unit, is
estimated for each activity. The product of the number of units

8. and the cost per unit gives the cost of each activity. Finally, the
activity costs are summed to obtain the total per procedure cost.
Many of the activity costs cannot be calculated without an
estimate of the number of ultrasounds that will be performed.
The best estimate is that 50 procedures would be done each
week, regardless of which alternative is chosen. Assuming the
technician works 48 weeks per year, the annual volume estimate
is 2,400 procedures. Of course, one factor that complicates the
analysis is that a much greater total volume can be
accommodated under Alternative 1 (with three machines) than
with Alternative 2 (with only one machine). However, to keep
the initial analysis manageable, the decision was made to
assume the same annual volume regardless of the alternative
chosen.
Other costs are thought to be relevant to the decision. First, in
addition to the purchasing and operating (primarily consisting
of fuel expenses) costs of the van, the estimated annual vehicle
maintenance costs are $1,000. Furthermore, annual
maintenance costs on each of the three ultrasound machines
under Alternative 1 are estimated at $1,000, whereas the annual
maintenance costs for the single machine under Alternative 2
are estimated higher, at $1,500, because of added wear and tear.
The manufacturer of the ultrasound machines has indicated that
a discount may be available if three machines, as opposed to
only one, are purchased. The amount of the discount is
somewhat uncertain, although 5 percent has been mentioned.
Finally, to get a rough estimate of the total annual costs over
the life of the equipment, assumptions about the useful life of
the ultrasound machines and the van must be made. Although
somewhat controversial, the decision was made to assume a
five-year life for both the ultrasound machines and the van and
that the value of these assets would be negligible at the end of
five years.
Instructions
You are the chair of the Network's ad hoc task force. Your
charge is to evaluate the two alternatives and to make a

9. recommendation on which one to accept, if revenues would be
identical for the two alternatives, and hence the decision can be
made solely on the basis of costs. As part of the analysis, the
costs of the two alternatives must be estimated on a per
procedure basis and an annual basis. In addition, any relevant
qualitative factors must be considered before the
recommendation is made.
To keep the base case analysis manageable, the task force was
instructed to assume that the operating costs remain constant
over the useful life of the equipment. For comparative purposes,
this assumption is not too egregious because the activities are
roughly the same for both alternatives and, hence, inflation
would have a somewhat neutral impact on the cost comparison.
In addition, the System CFO has asked the task force to perform
some sensitivity (scenario) analyses. He is concerned about the
accuracy of the cost detail inputs. Although he is confident
about many of the estimates, he thinks others are more
arbitrary. Those activity cost inputs considered to be most
uncertain are supplies cost per unit; billing and collection cost
per unit; general administration cost per unit; and
transportation, setup, and breakdown cost per unit.
Thus, first, the task force must redo the analysis assuming that
these inputs are higher than the base case values by 10 and 20
percent. Activity cost inputs less than the base case values
could also be examined, but the critical issue here is not to
underestimate the total costs involved in the two alternatives.
Second, the task force must determine what would happen to the
cost estimates if the useful life of the capital equipment were as
short as three years or as long as seven years. Another concern
was that the useful life of the equipment depended on the
alternative chosen; that is, there would be less wear and tear
under Alternative 1 than under Alternative 2. Finally, the task
force must assess the impact of a purchase discount: Would the
discount amount influence the ultimate decision?
You believe that performing a sensitivity analysis on the
number of procedures would be helpful, but you realize this task

10. would require recalculation of the per unit cost inputs, an effort
thought to be too time-consuming to undertake at this point in
the analysis.
With all the information above answer the following
Question 3
Redo the analysis assuming that the per unit supplies cost;
billing and collection cost; general administration cost; and
transportation, setup, and breakdown costs are higher than the
base case values by 10 percent. Redo the analysis again
assuming these costs are 20 percent higher than the base case
values.
Question 4
Return to the base case. What value for transportation and set-
up costs would make the costs of the two alternatives the same?
Question 5
Again, use all base case data but assume that a 5 percent
discount is available if three machines are purchased. What
effect does this have on the decision? What discount amount
would make the two alternatives equal in costs?
Redo the base case analysis assuming a useful life of 3 years.
Now assume a life of 7 years.
Question 6
Do the analyses conducted for Questions 3 through 6 affect your
decision as to which alternative has the lowest cost?
Exhibit 4.1EXHIBIT 4.1 Sooner Health Network: Activities
Associated with Alternatives 1 and 2Activities Associated with
Alternatives 1 and 21. Appointment scheduling2. Patient check-
in3. Ultrasound testing4. Patient check-out5. Film processing6.
Film reading7. Billing and collection8. General administration9.
Transportation, setup, and breakdown (Alternative 2 only)

11. Exhibit 4.2Exhibit 4.2 Sooner Health Network: Activity Cost
DetailActivityCost DriverVolumeCost per UnitAppointment
schedulingReceptionist time3 min$ 0.20Patient check-
inReceptionist time5 min$ 0.20Ultrasound testingTechnician
time30 min$ 0.40Physician time1.5 min$ 3.00Suppliesper
procedure$ 9.00Patient check-outReceptionist time5 min$
0.20Film processingTechnician time10 min$ 0.40Film
readingContract termsper procedure$ 40.00Billing and
collectionOverhead costsper procedure$ 6.80General
administrationOverhead costsper procedure$
1.25Transportation, setup, and breakdownTechnician time18
min$ 0.50Notes:1Physician time for testing (15 minutes) is
needed for one of every ten patients.2Supplies consist of linen,
probe cover, gel, film, and printer paper.3There are no
radiologist in the Network. Films will be read by the hospital's
radiologist at a contreact fee of $40 per procedure4Billing and
collection costs are based on an average cost per medical
services bill.5General administration costs are based on an
estimate of facilities and other administrative
costs.6Transportation, setup, and breadown are based on ten
procedures per day and include vehicle operating costs,
excluding maintenance.