The US spends the highest percentage of GDP on healthcare of any developed nation yet ranks only 37th in terms of effectiveness. The primary business model for US healthcare is fee-for-service which incentivizes providers to perform more services, including unnecessary ones, in order to increase profits. Alternative models like capitation could help contain costs by providing set budgets for lifetime patient care. However, moving entirely away from fee-for-service is difficult due to resistance from both providers and patients to loss of choice and income.
James G. Kahn, MD, MPH
Pharmacy Leadership Institute
Kaiser Permanente Development Program
Debate on Health Care Reform
Youtube: http://youtu.be/2ed0qRXMRBE
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
An Investigation of the Factors Affecting Capitation Programme in Provision ...inventionjournals
International Journal of Business and Management Invention (IJBMI) is an international journal intended for professionals and researchers in all fields of Business and Management. IJBMI publishes research articles and reviews within the whole field Business and Management, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Reinventing How Health Systems Manage Revenue and Can Improve the Economics o...revenuecyclem
Learn how healthcare organizations need to go beyond simply improving current revenue cycle management processes to create a brighter financial future.
Single Payer Systems: Equity in Access to Caresoder145
Presentation by Lynn Blewett at "The True Workings of Single Payer Systems: Lessons or Warnings for U.S. Reform' conference sponsored by the Journal of Health Politics Policy and Law, May 10 2008.
James G. Kahn, MD, MPH
Pharmacy Leadership Institute
Kaiser Permanente Development Program
Debate on Health Care Reform
Youtube: http://youtu.be/2ed0qRXMRBE
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
An Investigation of the Factors Affecting Capitation Programme in Provision ...inventionjournals
International Journal of Business and Management Invention (IJBMI) is an international journal intended for professionals and researchers in all fields of Business and Management. IJBMI publishes research articles and reviews within the whole field Business and Management, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online
Reinventing How Health Systems Manage Revenue and Can Improve the Economics o...revenuecyclem
Learn how healthcare organizations need to go beyond simply improving current revenue cycle management processes to create a brighter financial future.
Single Payer Systems: Equity in Access to Caresoder145
Presentation by Lynn Blewett at "The True Workings of Single Payer Systems: Lessons or Warnings for U.S. Reform' conference sponsored by the Journal of Health Politics Policy and Law, May 10 2008.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
The purpose of this project was to compare the current forest management planning process in New Brunswick with an alternative based largely on computer software tools. Two New Brunswick Crown Licenses were used as case studies: forest classification schemes, yield estimates and assumptions about forest dynamics used in the study were identical to those used by each of the participating Licensees in their respective forest planning models. However, Remsoft staff used Woodstock to develop a strategic forest management schedule, Crystal to generate potential harvest blocks and Block to develop a spatially feasible block harvest schedule.
Current System Issues and Their ImpactsIntroductionBefore we .docxalanrgibson41217
Current System Issues and Their Impacts
Introduction
Before we can discuss change and innovation in our health care delivery system, a strong understanding of the current system is necessary, including how it functions, what types of incentives are at work, and how the different entities inside it work with and impact each other.
What Elements Drive Our Current System?
There are several key drivers of the existing system, and among these are the money, providers, payers, and consumers. When examining the behavior of any system, it is useful to look at the series of rewards and consequences that drive behavior. In health care, this means that much can be learned about the system's behavior by following the money trail. What things are reimbursed, under what circumstances, and with what outcomes? Under what circumstances are consequences, such as not getting paid, applied? In the current system, payments are highest for procedures, and proceduralists such as surgeons, gastroenterologists, and interventional cardiologists are all paid much higher fees than are family practice physicians, pediatricians, or hospitalists, all of whom manage medical care. Hospitals function under the same premise. Approximately 75% of the revenue for the average community hospital comes from surgeries, and another 12% comes from diagnostic imaging procedures. Additional amounts come from cardiac diagnostic and interventional procedures. So, approximately 90% to 95% of revenue comes from performing procedures on patients rather than providing management of diseases through medications or other noninvasive treatments. Thus, the system is focused on rewarding procedures that lead to "curing" and focused away from medical management of chronic diseases or prevention of disease and illness.
Financial Elements
Without doubt, money is one of, if not the, most powerful drivers of system functioning. For a classic example, we can look at the old fee-for-service payment methodology prevalent in the 1960s and 1970s, and contrast it with Medicare's implementation of diagnosis-related groups (DRGs) as a payment mechanism in 1983. Under fee-for-service health care, providers used whatever procedures, equipment, and supplies they felt were needed for care, and they submitted a bill that charged for each item. The payors received the bill, corrected any errors, and then issued a check for the corrected amount to the providers. If a provider wished to make a larger profit, they could provide more services or billable items to increase the payment. It comes as no great surprise to note that utilization of services and cost both rose rapidly under this methodology, since there was no incentive to be frugal. When Medicare changed its reimbursement to DRGs, the system began to experience the impact of being paid one flat fee, set by DRG, for the entire admission, regardless of how much care was rendered. For example, if a hospital provided care at a cost below the DRG payment, it was ab.
In July 2018, NITI Aayog published a Strategy and Approach document on the National Health Stack. The document underscored the need for Universal Health Coverage (UHC) and laid down the technology framework for implementing the Ayushman Bharat programme which is meant to provide UHC to the bottom 500 million of the country. While the Health Stack provides a technological backbone for delivering affordable healthcare to all Indians, we, at iSPIRT, believe that it has the potential to go beyond that and to completely transform the healthcare ecosystem in the country. We are indeed headed for a health leapfrog in India! Over the last few months, we have worked extensively to understand the current challenges in the industry as well as the role and design of individual components of the Health Stack. In this post, we elaborate on the leapfrog that will be enabled by blending this technology with care delivery.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
Chapter 9 Comprehensive BenefitsAnother important measure of heJinElias52
Chapter 9
"Comprehensive BenefitsAnother important measure of health care systems is whether they offer all of theessential services individuals need. The difficulty lies in defining what is essential.Although all observers would agree that comprehensive health care must includecoverage forprimary care, agreement breaks down quickly when we begindiscussing specialty care. Some individuals, for example, consider coronary bypasssurgery an essential service, but others consider it an overpriced and overhypedluxury. Similarly, some favor offering only procedures necessary to keep patientsalive, but others support offering procedures or technologies such as hip replace-ment surgery, home health care, hearing aids, or dental care, which improvequality of life but don’t extend life.Any system that does not provide comprehensive benefits runs the risk ofdevolving into a two-class system in which some individuals can buy more carethan others can. To those who believe health care is a human right, such a sys-tem seems unethical. Others object to such systems on economic grounds, argu-ing that it costs less in the long run to plan on providing care for everyone thanto haphazardly shift costs to the general public when individuals who can’t affordcare eventually seek care anyway.AffordabilityGuaranteeingaccessto health care does not help those who can’t afford topur-chaseit. Consequently, we also must evaluate health care systems according towhether they make health care coverage affordable, restraining the costs notonly of insurance premiums but also ofco-payments, deductibles, and othercrucial services such as prescription drugs and long-term care. Although the ACAoffers some subsidies and tax credits to help people pay their premiums, it stillleaves millions with many bills for these latter costs.For health care to be affordable, individual costs must reflect individualincomes. As noted earlier, most insured Americans receive their insurancethrough employers. Typically, employers pay part of the cost for that insuranceand deduct the rest from each employee’s wages. Because low- and high-wageworkers have their salaries reduced by the same dollar amount, low-wage work-ers are effectively hit harder: Paying $3,000 per year for health insurance might,for example, force a wealthier worker to scale back his vacation plans but force apoorer worker to put off fixing his roof. For this reason, the US system is con-sideredfinancially regressivein that poorer people must pay a higher percent-age of their income than do wealthier people. In contrast, in countries such asGreat Britain and Canada, health coverage is paid for through graduated in-come taxes. Poorer persons pay alowerpercentage of their income for taxesand therefore for health care than do wealthier persons, creating afinanciallyprogressivesystem. Either way—whether through taxes or lowered wages—the nation’s citizens pay all the costs of health care" "Financial EfficiencyAnother critical measure of ...
Value-Based Purchasing and the Role of Home Care TechnologyAlayaCare
While shifting financial models is a major challenge facing healthcare, we can safely assume where that shift is heading. As it stands, there continues to be a paucity of good evidence as to how to run an effective Value-Based Purchasing (VBP) program, and definitive metrics on how it can lead to better outcomes. Thus, this shift is underway filled with far more expectations than answers.
With this guide will you learn how your home care agency can prepare, adapt and thrive in a value-based purchasing landscape with the help of modern home care technology.
DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
How to Manage Population Health Effectively in Accountable Care OrganizationsPhytel
The Affordable Care Act authorized a Medicare shared-savings program for accountable care organizations, and private payers are also contracting with ACOs. To succeed, ACOs must learn how to manage population health effectively.
Running Head PERTINENT HEALTHCARE ISSUE1PERTINENT HEALTHCAR.docxtodd581
Running Head: PERTINENT HEALTHCARE ISSUE 1
PERTINENT HEALTHCARE ISSUE 2
Analysis of Pertinent Healthcare Issue
Students Name:
Institutional Affiliation:
Impact of increasing cost in a health organization
Introduction
The cost of receiving healthcare service is becoming a serious national healthcare concern. It has been established that the United States spend more on healthcare, in relation to the national income than any other industrialized nation. However, achieving minimum cost means having to make certain hard compromises which have never been easy. For example, low expenditure on research and development, limitation in terms of the choices of health coverage or healthcare providers and having to wait for long before using new technologies. The health system has gone through a series of transformational changes that has seen the cost of healthcare provision sky-rocket. The most affected are among the 41 million uninsured Americans who are unable to cater for the cost of insurance as well as the underinsured whose coverage program cannot cater for their overall health needs. The major catalyst behind the rising cost of healthcare has been; the rising number of aging population that take great benefit from the technologies created for lengthening life span, lifestyle choices like adoption of sedentary lifestyle and unhealthy eating habits resulting to obesity and cardiovascular disorders among others.
Cost impact on health organization.
Increasing cost has impacted the national health organization/system in so many ways. The impacts are not only experienced by the patients but the providers, employers, payers (insurance bodies) and even other employees within the health organization. Firstly, an array of transformational changes has been made i.e. payment transformation where a shift has been made from volume-based (fee-for service payment) which has high cost implications to value-based models and also the development of primary care in attempt to counter increasing cost. The turnover of healthcare providers has also faced a fair share of cost impact. The providers burdened by the feeling of denying patients services due to inability to cater for cost or lack of insurance loses meaning of services and morale to continue with the service. Consequently, advancement in training and education improve the providers’ patient service and more enhanced application of Evidence-Based practice appears costly and unaffiliated hence promoting low morale. Morbidity and mortality cases has been on the rise. Advanced technology used in diagnosis/treatment of serious medical conditions has become expensive and some of them are not covered by the insurance (core payments) hence late interventions taken after serious damage. The is also an indication of lowered patient engagement as far healthcare decision making is concerned since patients with financial challenge have limited options and are sometimes forced to comply with the physici.
Running Head PERTINENT HEALTHCARE ISSUE1PERTINENT HEALTHCAR.docxglendar3
Running Head: PERTINENT HEALTHCARE ISSUE 1
PERTINENT HEALTHCARE ISSUE 2
Analysis of Pertinent Healthcare Issue
Students Name:
Institutional Affiliation:
Impact of increasing cost in a health organization
Introduction
The cost of receiving healthcare service is becoming a serious national healthcare concern. It has been established that the United States spend more on healthcare, in relation to the national income than any other industrialized nation. However, achieving minimum cost means having to make certain hard compromises which have never been easy. For example, low expenditure on research and development, limitation in terms of the choices of health coverage or healthcare providers and having to wait for long before using new technologies. The health system has gone through a series of transformational changes that has seen the cost of healthcare provision sky-rocket. The most affected are among the 41 million uninsured Americans who are unable to cater for the cost of insurance as well as the underinsured whose coverage program cannot cater for their overall health needs. The major catalyst behind the rising cost of healthcare has been; the rising number of aging population that take great benefit from the technologies created for lengthening life span, lifestyle choices like adoption of sedentary lifestyle and unhealthy eating habits resulting to obesity and cardiovascular disorders among others.
Cost impact on health organization.
Increasing cost has impacted the national health organization/system in so many ways. The impacts are not only experienced by the patients but the providers, employers, payers (insurance bodies) and even other employees within the health organization. Firstly, an array of transformational changes has been made i.e. payment transformation where a shift has been made from volume-based (fee-for service payment) which has high cost implications to value-based models and also the development of primary care in attempt to counter increasing cost. The turnover of healthcare providers has also faced a fair share of cost impact. The providers burdened by the feeling of denying patients services due to inability to cater for cost or lack of insurance loses meaning of services and morale to continue with the service. Consequently, advancement in training and education improve the providers’ patient service and more enhanced application of Evidence-Based practice appears costly and unaffiliated hence promoting low morale. Morbidity and mortality cases has been on the rise. Advanced technology used in diagnosis/treatment of serious medical conditions has become expensive and some of them are not covered by the insurance (core payments) hence late interventions taken after serious damage. The is also an indication of lowered patient engagement as far healthcare decision making is concerned since patients with financial challenge have limited options and are sometimes forced to comply with the physici.
Disaster Contact a disaster preparedness person at either a loca.docxlynettearnold46882
Disaster
Contact a disaster preparedness person at either a local hospital, or local city or county emergency services agency. NORTHEAST OHIO
1. Blackout 2003
2. Chardon Highschool shooting 2012
3. Great blizzard 1978
Interview your contact, asking the following questions:
1) "What do you consider to be the top three disasters for which you prepare?"
2) "What would you say are your top three lessons learned about managing a disaster?"
What Would the Best Future for Health Care Look Like?
Introduction
The one thing the debate over reforming health care taught us all is that there are as many opinions as there are interested groups, and all of them differ in meaningful ways. To look at the views on improving the systems of care delivery, it is important to note where they have points of agreement and where they differ. They are all driven by the values and principles of the constituencies and what they hope to achieve from changes in the delivery system. This module will explore points of agreement and differences between important groups that will influence the direction health care will go in the next decade.
Patients
It is an interesting point that all constituencies, in their public statements, emphasize that a strong health care system should focus on getting the best outcomes for patients. What would that be, from the perspective of patients? Typically, patients relate that they want top quality in their care and the latest technology, along with immediate and unrestricted access to care, at the lowest possible cost. This triad has become the stumbling block of change initiatives, since to date, no one has figured out how to deliver all three. However, when patients' views are explored and probed, some interesting facts emerge. When patients say they want top quality care, in general, they tend to define that as achieving a cure or return to health. They certainly do not want to leave the system feeling worse than when they came in. Patients have been heavily lobbied in the media by pharmaceutical and medical technology companies to convince them that the latest (and most expensive) technology will deliver the desired outcomes. However, very little real research on the true effectiveness of treatments and technology makes its way to most patients, and patients in general do not shop for their medical care as carefully as they would if they were purchasing new cars, for example. The language of research and medicine is difficult for patients to understand and is frequently not well-explained by providers.
So, the nuances of top quality care in terms of being able to deliver a cure or return to health are not well understood by the constituency with the most at risk. What patients do understand is whether they feel better or see improvement in their health and whether care was rendered without errors and in a compassionate way. The best health care system, from a patient's point of view, is one that can consistently deliver the good.
Running head: PUBLIC HEALTH
1
PUBLIC HEALTH
6
Public Health
Student’s name
University affiliation
Public Health
•
Briefly describe the public health problem and the policy that addresses the problem.
The public health problem of interest is limited accessibility of quality and affordable health care due to a rising cost of health care services. This is a major issue which has affected millions of Americans especially those who cannot afford to pay for their health care insurance or pay directly for health care services. The rising cost of health care services includes the rising prices of prescription charge, primary care, and specialized care which have limited the accessibility of quality health care. Some of the effects of rising health care cost include; i) rising insurance premiums, ii) limited access to specialized care such as breast cancer screening and maternal care for women, and iii) limited access to specialized care for different vulnerable groups such as persons who have chronic health conditions or those who are at a high risk of getting chronic illnesses.
To address this public health problem, the federal government introduced the Patient Protection and Affordable Care Act which famously known as Obama Care. This policy was signed by President Barack Obama in March 2010 with the goal of bringing key reforms in the health care sector to address the problem of health care cost, quality, and access. The primary objectives of the Affordable Care Act (ACA) were to; prevent the increase in the cost of prescription drugs and health care services, ensure that all citizens could have access to affordable health insurance coverage, promote patient protection, and deliver better services (Amadeo, 2019).
• Examine the nature and magnitude of the problem and the people who are affected.
Generally, the issue of increasing health care cost affected all Americans, especially those who could not afford health insurance coverage and the vulnerable population groups. Persons who could not afford health insurance could not access quality health care services since they were very expensive and they would not afford to cater for out-of-pocket payments. Vulnerable population groups included the aging population who are the most vulnerable group to be affected by chronic illnesses. The high cost of medication limited the ability of the affected group to access quality health care thus leading to a high mortality rate. The magnitude and nature of the high cost of health care can be analyzed as follows.
Rising insurance premiums
As of 2004, the cost of health care services had increased by 4 percent. Quality health care services and prescription drugs were getting expensive forcing the healthcare insurance providers to increase their premiums. Premiums were rapidly increasing between 2000 and 2010 at a rate of 8 percent for family premiums covered by employers (Amadeo, 2018). Due to this, hundreds of tho.
Will bank loans increase, or decrease? Will this stop the recovery in its tracks. Fed at moment is "puchasing" $85 bn in assets from banking system as traditional monetray policy is in "liquidity trap".
how to swap pi coins to foreign currency withdrawable.DOT TECH
As of my last update, Pi is still in the testing phase and is not tradable on any exchanges.
However, Pi Network has announced plans to launch its Testnet and Mainnet in the future, which may include listing Pi on exchanges.
The current method for selling pi coins involves exchanging them with a pi vendor who purchases pi coins for investment reasons.
If you want to sell your pi coins, reach out to a pi vendor and sell them to anyone looking to sell pi coins from any country around the globe.
Below is the contact information for my personal pi vendor.
Telegram: @Pi_vendor_247
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
Resume
• Real GDP growth slowed down due to problems with access to electricity caused by the destruction of manoeuvrable electricity generation by Russian drones and missiles.
• Exports and imports continued growing due to better logistics through the Ukrainian sea corridor and road. Polish farmers and drivers stopped blocking borders at the end of April.
• In April, both the Tax and Customs Services over-executed the revenue plan. Moreover, the NBU transferred twice the planned profit to the budget.
• The European side approved the Ukraine Plan, which the government adopted to determine indicators for the Ukraine Facility. That approval will allow Ukraine to receive a EUR 1.9 bn loan from the EU in May. At the same time, the EU provided Ukraine with a EUR 1.5 bn loan in April, as the government fulfilled five indicators under the Ukraine Plan.
• The USA has finally approved an aid package for Ukraine, which includes USD 7.8 bn of budget support; however, the conditions and timing of the assistance are still unknown.
• As in March, annual consumer inflation amounted to 3.2% yoy in April.
• At the April monetary policy meeting, the NBU again reduced the key policy rate from 14.5% to 13.5% per annum.
• Over the past four weeks, the hryvnia exchange rate has stabilized in the UAH 39-40 per USD range.
What price will pi network be listed on exchangesDOT TECH
The rate at which pi will be listed is practically unknown. But due to speculations surrounding it the predicted rate is tends to be from 30$ — 50$.
So if you are interested in selling your pi network coins at a high rate tho. Or you can't wait till the mainnet launch in 2026. You can easily trade your pi coins with a merchant.
A merchant is someone who buys pi coins from miners and resell them to Investors looking forward to hold massive quantities till mainnet launch.
I will leave the telegram contact of my personal pi vendor to trade with.
@Pi_vendor_247
The European Unemployment Puzzle: implications from population agingGRAPE
We study the link between the evolving age structure of the working population and unemployment. We build a large new Keynesian OLG model with a realistic age structure, labor market frictions, sticky prices, and aggregate shocks. Once calibrated to the European economy, we quantify the extent to which demographic changes over the last three decades have contributed to the decline of the unemployment rate. Our findings yield important implications for the future evolution of unemployment given the anticipated further aging of the working population in Europe. We also quantify the implications for optimal monetary policy: lowering inflation volatility becomes less costly in terms of GDP and unemployment volatility, which hints that optimal monetary policy may be more hawkish in an aging society. Finally, our results also propose a partial reversal of the European-US unemployment puzzle due to the fact that the share of young workers is expected to remain robust in the US.
how to sell pi coins in all Africa Countries.DOT TECH
Yes. You can sell your pi network for other cryptocurrencies like Bitcoin, usdt , Ethereum and other currencies And this is done easily with the help from a pi merchant.
What is a pi merchant ?
Since pi is not launched yet in any exchange. The only way you can sell right now is through merchants.
A verified Pi merchant is someone who buys pi network coins from miners and resell them to investors looking forward to hold massive quantities of pi coins before mainnet launch in 2026.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
What website can I sell pi coins securely.DOT TECH
Currently there are no website or exchange that allow buying or selling of pi coins..
But you can still easily sell pi coins, by reselling it to exchanges/crypto whales interested in holding thousands of pi coins before the mainnet launch.
Who is a pi merchant?
A pi merchant is someone who buys pi coins from miners and resell to these crypto whales and holders of pi..
This is because pi network is not doing any pre-sale. The only way exchanges can get pi is by buying from miners and pi merchants stands in between the miners and the exchanges.
How can I sell my pi coins?
Selling pi coins is really easy, but first you need to migrate to mainnet wallet before you can do that. I will leave the telegram contact of my personal pi merchant to trade with.
Tele-gram.
@Pi_vendor_247
how can i use my minded pi coins I need some funds.DOT TECH
If you are interested in selling your pi coins, i have a verified pi merchant, who buys pi coins and resell them to exchanges looking forward to hold till mainnet launch.
Because the core team has announced that pi network will not be doing any pre-sale. The only way exchanges like huobi, bitmart and hotbit can get pi is by buying from miners.
Now a merchant stands in between these exchanges and the miners. As a link to make transactions smooth. Because right now in the enclosed mainnet you can't sell pi coins your self. You need the help of a merchant,
i will leave the telegram contact of my personal pi merchant below. 👇 I and my friends has traded more than 3000pi coins with him successfully.
@Pi_vendor_247
Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...Quotidiano Piemontese
Turin Startup Ecosystem 2024
Una ricerca de il Club degli Investitori, in collaborazione con ToTeM Torino Tech Map e con il supporto della ESCP Business School e di Growth Capital
NO1 Uk Black Magic Specialist Expert In Sahiwal, Okara, Hafizabad, Mandi Bah...Amil Baba Dawood bangali
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1. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
Independent Research & Management
US HEALTHCARE COSTS:
Why US Healthcare is most expensive in world and yet ranks 37th in developed
world in terms of effectiveness
In 2008 the US spent 16.2% of its resources services they provide.
[as measured by overall cost of health care
as % GDP]. Yet quality in US is consistently An alternative business model is for each
ranked lower than Holland, Great Britain patient to be provided a lifetime healthcare
and Germany which have ―socialized‖ budget, over and above which the patient is
healthcare systems. In a 2008 survey of responsible for the costs. If a patient stays
quality of Healthcare service provided, the healthy his entire life, his lifetime budget
US ranked 37th. would not be drawn down. What would
happen to these funds dependson the type
US healthcare is primarily of ―fee for of approach one takes; in theory this should
service‖[FFS] business model. Healthcare accrue to the patient for use whatever way
providers are paid on the basis of the they choose.
amount of services they provide. Doctors
as entrepreneurs, make money on The choice of business model has a huge
treatments that they can provide; the more impact on the overall economic sustainability
service or drugs they can prescribe, the of the payers of health care, ~ patients and
more money they make. Clearly in a FFS insurers.
world it is in the interest of Medical service
providers to maximize the volume of
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2. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
Since 1960 the cost of healthcare in the United
States as % GDP has tripled. The Congressional
Budget Office has estimated that in 2025 is
expected to quadruple to 24% of GDP, if the
business model that has been adopted by the
healthcare providers does not change. If
unchecked in 2080, Healthcare will consume >
40% of GDP.
It is inherently dangerous for one sector of the
economy to account for >40% of national
resources, as we saw when the financial system
crashed in 2008. By 2008 the US financial system
accounted for > 40% of all S&P 500 profits.
The cost of healthcare in the United States is
borne principally by employers, who pay
premiums to insurers and by individuals who
either un-insured or have own insurance.
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3. Gnostam LLC January 31st, 2012 Newsletter
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Inverness, CA 94937
This paper examines ways in which patients
and insurers can contain healthcare costs.
STRUCTURE OF HEALTHCARE IN US:
The US system as we have discussed is a
fee for service system, [FFS]. This
business model is a payment model in
which services are unbundled each service
is paid for separately. In an entrepreneurial
healthcare system, it incentivizes physicians
to provide more treatments (including
unnecessary ones) because payment is
dependent on the quantity of care, rather
than quality of care. Similarly, when patients
are shielded from paying (cost-sharing) by
health insurance coverage, they are
incentivized to welcome any medical service
that might do some good. A variety of
reform efforts have been attempted,
recommended, or initiated to reduce its
influence (such as moving towards bundled
payments and capitation, or per capita
services).
The table on the left demonstrates the
effects of the FFS. The US system
essentially costs 3 times for the same
healthcare than it would cost a patient in
New Zealand, considered one of the top
countries in the world for quality of life and
living standards.
A simple check up in the US costs double
what it costs in Canada or the Netherlands.
Canada has the highest quality of life index
in the world, and is a developed country.
A hospital visit in America costs three times
what a hospital visit costs in France. Many
Hospitals in America have extensive art
collections on the walls, plush facilities and
extra-ordinary overhead expenses, all of
which are being paid for by the patient and
the insurer.
WHY THE COSTS ADD UP UNDER FFS:
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4. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
FFS payments are issued retrospectively, primary care physicians to invest in radiology
after the services are provided. One of the clinics and perform physician self-referral in
main features of FFS, is that no cost order to generate income.This vertically
savings are negotiated for an entire integrated business model creates very large
procedure up front.FFS causes an barriers to entry and local heathcare provider
inflationary pressure on costs, as no monopolies are very common in regions all
bundled services can be priced, raising over the USA. FFS has been a barrier to
health care costs. FFS also creates a coordinated care, or integrated care—
potential financial conflict of interest with exemplified by the Mayo Clinic—because it
patients, as it incentivizesoverutilization— rewards individual clinicians for performing
treatments with either an inappropriately separate treatments.FFS also does not pay
excessive volume or cost, nor does it providers to pay attention to the most costly
incentivize physicians to withhold patients,ones that could benefit from
services. When bills are paid under FFS interventions such as phone calls that can
by a third party, patients (along with make some hospital stays and 911 calls
doctors) have no real incentive to consider unnecessary. FFS became the main
the cost of treatment.When patients ―are healthcare business model after WWII when
insulated from the cost of a desirable there was need for a business model that
product or service, they use more", such could deal with high inflation; thus was born
as endless medical tests, diagnostics and the inflation monster ~ FFS. The familiarityof
procedures. There is a large body of FFS to doctors and patients in the USis the
evidence that suggests primary care main reason FFS is seen by many patients as
physicianspaid under a FFS model, tend the only or main payment method, [e.g.
to treat and refer patients to more Medicare is FFS]. Doctors as entrepreneurs
procedures than those paid under want to be reward for output not
capitation or a salary. FFS incentivizes effectiveness, so FFS does just that. The
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5. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
Soviet Union’s economic system also providers a set amount for each enrolled
rewarded output not effectiveness in meeting person assigned to that physician or group
consumer demand. The ―heaviest‖ TV sets of physicians, whether or not that person
in the world were produced in the Soviet seeks care, over time, such as lifetime of
Union, because output = weight. So in the the patient.
US we have the ―heaviest‖ healthcare
system, a result of FFS. Providers are contracted through health
maintenance organizations (HMO) known
as an independent practice association
It is important to note that General (IPA). The providers contract with the HMO
Practitioners have less autonomy after to take care of patients enrolled in the
switching from an FFS model to integrated HMO.
care.Patients, who moved from an FFS
model saw their choice of physicians The amount of remuneration is based on
restricted, as was done in the Netherlands in the average expected health care
their attempt to move towards coordinated utilization of that patient (more
care. remuneration for patients with significant
medical history). Other factors considered
In a business model where physicians include age, race, sex, type of
cannot bill for a service, it serves as a employment, and geographical location, as
disincentive to perform that service if other these factors typically influence the cost of
billable options exist. In an electronic referral, providing care.
for example, a specialist evaluates medical
data (such as laboratory tests or examination
of images) to diagnose a patient instead of MOVING OFF AN FFS SYSTEM:
seeing the patient in person;this has been
found to improve health care quality and
lower costs. The economies of scale of this Proponents of leaving an FFS system
approach might finally be passed onto the argue that this increased efficiency,
payer of the service, patient or insurer. It improved overall quality standards, leading
should be noted that, "in the private fee-for- to a better understanding of the economic
service context, the loss of specialist income relationship between costs and quality,
is a powerful barrier to e-referral, a barrier cost and volume of services provided.
that might be overcome if health plans According to a 2002 Juran Institute study,
compensated specialists for the time spent there is no consistent, direct correlation
handling e-referrals". between the cost of care and its quality.
The "cost of poor quality" is in effect
In Canada, the proportion of services billed
caused directly by FFS overuse, misuse,
under FFS over the period of 1990 to 2010
and/or waste amounts to 30 percent of all
shifted substantially. Less care was paid out
direct health care spending.The emerging
for patients under the age of 55 while for
practice of evidence-based medicine is
those over 65, payment for diagnostic
being used to determine when lower-cost
services was sharply increased.
medicine may in fact be more effective.
Critics of managed care argue that "for-
ALTERNATIVE BUSINESS MODELS: profit" managed care has been an
unsuccessful health policy, as it has
Capitation: Capitation is defined as a contributed to higher health care costs (25-
method for paying health care service 33% higher overhead at some of the
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6. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
largest HMOs), increased the number of bonuses depending upon patient
uninsured citizens, driven away health care performance. Utah's Intermountain
providers, and applied downward pressure Healthcare, the Cleveland Clinic, and Kaiser
on quality (worse scores on 14 of 14 quality Permanente also use a coordinated
indicators reported to the National healthcare system in alternative to FFS.
Committee for Quality Assurance). However while coordinated care can
produce cost savings of ~ 50% when
The most common managed care financial
compared to FFS programs, long term
arrangement, ~ capitation, places health
savings may be compromised by Physicians
care providers in the role of micro-health
wanting higher base compensation because
insurers, assuming the responsibility for
of the loss ―volume‖ business relative to
managing the unknown future health care
FFS. [See interesting study by Peter Zweifel
costs of their patients. Small insurers, like
(March 2011). "Swiss experiment shows
individual consumers, tend to have annual
physicians, consumers want significant
costs that fluctuate far more than larger
compensation to embrace coordinated
insurers.
care". Health Affairs (Project Hope)30 (3):
510–518].
"Professional Caregiver Insurance Risk‖
describes the inefficiencies in health care
finance resulting from the inefficient transfer ACCOUNTABLE CARE
of insurance risks to health care providers ORGANIZATIONS:
who are expected to cover such costs in
return for their capitation payments. As a One of the goals of accountable care
study by Thomas Cox Ph.D RN (2006) organizations (ACOs), part of the 2010 U.S.
shows, providers may not be adequately Patient Protection and Affordable Care Act
compensated for their insurance risks, (PPACA), has been to move from FFS to
without forcing managed care organizations integrated care.ACOs, however, fit largely
to become price uncompetitive vis-à-vis risk into a FFS framework, and do not abandon
retaining insurers. Cox (2010) also shows the model entirely, as has been pointed out
that smaller insurers have lower probabilities by John K. Iglehart (April 2011) in"The ACO
of modest profits than large insurers, higher regulations – some answers, more
probabilities of high losses than large questions". The New England journal of
insurers, provide lower benefits to medicine. This approach suggests
policyholders, and have far higher surplus policymakers are attempting to avoid
requirements. All these effects work against provoking public outcry, as happened with
the viability of health care provider insurance managed care in the 1990s by giving
risk assumption. providers incentives to give less care.The
Moving away from FFS towards pay for PPACA aims to first move Medicare away
performance introduces quality and from FFS, then other payers.A Swiss Peter
efficiency incentives, instead of solely Zeiwfel study showed physicians wanted
rewarding quantity. significant pay raises to leave FFS for an
integrated care model, while patients wanted
The famous Mayo Clinic, has among others, lower premiums before they would choose
offered a system that serves as a one, results that hint at difficulties for
coordinated/integrated care alternative to PPACA aims.
the FFS model. The Pennsylvania
Geisinger Health System has a system In China—where FFS resulted in costly,
where the physicians, residents and fellows inefficient, and poor quality health care with
are paid a salary with the potential for a degeneration in medical ethics—reforms
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7. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
have been initiated to realign health care legislative mandate to come up with a plan
provider incentives, see Winnie Chi-Man to tackle costs (the Massachusetts Payment
Yip, William Hsiao, Qingyue Meng, Wen Reform Commission); they unanimously
Chen&Xiaoming Sun (March 2010) and concluded the FFS model must be done
"Realignment of incentives for health-care away with. Their plan included a move away
providers in China". The Lancet . from FFS to a global payment system that
Experimentation with new payment models had similarities to a capitated system. No
is ongoing with recommendations including U.S. state, up to 2009, had attempted to do
a strengthening of medical ethics, alignment away with FFS. The Medicare Payment
of provider's profit motives with patient Advisory Commission(MedPAC), in their
needs, and, in cases where hospitals retain mid-2011 report to Congress, called for a
their profit motive, segregating physicians mechanism so that Medicare
from the goal of profit. beneficiaries would have disincentives to
In the 1990s the move in the US from FFS undergo discretionary care, but not
to pure capitation provoked a backlash from needed care.
patients and health care providers. Pure
capitation pays only a set fee per patient, WHY CONSOLIDATION IN INSURANCE
regardless of sickness, giving physicians an INDUSTRY HAS NOT BROUGHT LOWER
incentive to avoid the most costly patients.In COSTS:
order to avoid the pitfalls of FFS and pure
capitation, models of episode-of-care One of the mysteries of Healthcare
payment and comprehensive care payment Insurance is why consolidation resulting in
have been proposed.In 2009, the U.S. state larger insurers has not provided lower costs,
of Massachusetts (with the then highest as we should have expected had the
health care costs in the country) had a group Thomas Cox Ph.D RN ―case‖ studies of
of ten health care experts who worked under 2000 2011. Two studies published by Health
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8. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
Affairs, the bible of health policy, document business professor at the University of
the shortcomings of health industry California at Berkeley, have also weighed in
consolidation. with their study of hospital mergers two
years out. It shows that costs increased, not
James Robinson, a professor of health decreased, that there was no improvement
economics, calculates that the top 3 health in basic quality measures such as mortality
insurance companies control two-thirds or and adverse safety events, and that prices
more of the business in all but 14 states, increased 7.7 percent for managed care
with numbers reaching as high 92 percent in customers and 4.1 percent for fee-for-
Maryland and 98 percent in the District and service plans.
Northern Virginia.
How do we explain these data?
Robinson juxtaposes these numbers with
the 2000 to 2003 financial results of the top In the case of hospital mergers, Cuellar
five national firms. He shows a decline in the states that administrative efficiencies wind
percent of each premium dollar that goes to up being minimal, while efforts to realize
cover medical costs, along with an even operational efficiency often run into a stone
stronger trend toward higher premiums, wall of opposition from doctors uninterested
profit and stock prices. While this doesn't in changing the way they practice. That was
prove causality, it certainly raises serious the undoing of the merger between Mount
questions about the consumer benefits of Sinai and New York University hospitals in
consolidation. New York, she said.
Alison Evans Cuellar, an economist at Meanwhile, the effort to gain negotiating
Columbia University, and Paul Gertler, a leverage through mergers often proves to be
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9. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
an arms race with no winners. Insurance based medical practices that hold out the
mergers beget hospital mergers, and vice best promise for lowering costs and
versa, neutralizing any negotiating advantage. improving medical outcomes. In the few
places where such innovations have
One result of all this consolidation is the taken hold, it turns out that management
reduced chance of a new entrant coming along and culture are the key factors, not scale.
to shake things up with a new technology or
business model. In a world where giants deal
only with giants, that's not likely. CONCLUSIONS:
An emerging source of competition has come There is undoubtedly a need on the part
from regional companies deciding to grow the of insurance companies to be pro-active
old-fashioned way, moving into geographically with both patients and healthcare
adjacent markets to win new customers. But providers so as to formulate a strategy for
now that national insurers have gobbled up cost reduction in healthcare.
most of the regional players, there aren't many
left. [UnitedHealth's purchase of MAMSI and In the view of the authors of this paper, it
Oxford in the Virginia/Maryland areas]. is very likely that the very same
experience curve effects that exist in any
As for the newly merged hospital "systems," other industry exist for healthcare
some -- like Inova Health System's nicely providers as well. [An example of the
profitable "nonprofit" operation in Northern ―effect‖ of an experience curve on overall
Virginia -- are now so dominant they have costs is shown overleaf].
become somewhat immune to competitive
pricing pressures. We submit that it is likely that healthcare
providers have deliberately promoted the
FFS business model because it
Others have discovered that they so overpaid
maximized revenues, while allowing them
for recent acquisitions, or have become so
to ―privatize‖ almost all the gains from
stymied by integration issues, that they have
―experience effects‖ for the provider.
neither the time nor money to leverage the
benefits of size to install computerized record
In order to reduce the rate of increase of
systems or introduce the kind of evidence-
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10. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
healthcare costs for patients, it is essential accept these types of new business models,
to begin to move the industry off FFS and to and how to reconcile the conflicting priorities
a capitation business model. Employers are of patient needs, health-insurers and the
pushing this change of business model, as profit motives of health care providers is the
the healthcare insurance costs are the subject for another paper.
highest benefit cost facing employers.
Gnostam LLC
Many employers like for example Pitney
Bowes who have a young healthy hourly Philip Corsano
work force, are insisting that these Patrick Kelly
employees do not opt out of healthcare
coverage while at the same time promoting
a form of capitation.
For more than a decade Pitney Bowes has
provided subsidies that make coverage
more affordable for lower-wage workers. It
seems to work: 78 percent of U.S.
employees opt for health coverage at Pitney
Bowes. Starting this year, the company took
a step that ties health coverage costs even
more closely to pay. In its consumer-
directed health plan, the company sets the
deductible, out-of-pocket maximum and
company contribution based on salary.
Hourly workers, for example, have a $1,500
deductible and $3,000 out-of-pocket
maximum, while employees at the director
level or higher have a $2,500 deductible and
$5,000 out-of-pocket maximum.
How to drive a patient and provider to
Bibliography:
Gosden T, Forland F, Kristiansen IS et al [2000] “Capitation, salary, fee-for service and mixed
systems of payment: effects on the behavior of primary care physicians, Cochrane Database
Syst. Rev;
Thomas Bodenheimer [March 2008] “Coordinating care – a perilous journey through the
healthcare system” The New England Journal of Medicine [358-10];
Medicare Option in Biden Budget talks get a boost. NPR, Associated Press June 2011;
Rachel Mendleson [Oct 25th 2010]. “The worst run industry in Canada – Healthcare. Canadian
Business;
Phil Galewitz: Jordan Rau and Bara Vaida [March 31st 2011]. Accountable Healthcare expected
to save millions, Kaiser Health New, [McClatchy];
Peter Zweifel, [March 2011] “Swiss Experiment shows that physicians, consumers want
significant compensation to embrace coordinated healthcare, Health Affairs, [Project Hope]
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11. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
510-518;
Thomas Cox Ph.D RN, 2011 “Exposing the true costs of capitation financed healthcare” Journal
of Healthcare Risk Management 30-34;
Thomas Cox Ph.D RN, 2011 “Standard Errors of our failing healthcare [finance] systems and
how to fix them;
Thomas Cox Ph.D RN, 2010 “Legal and Ethical Implications of Healthcare Provider Insurance
Risk Assumption. Jona’s Healthcare Law, Ethics and Regulation 106-114;
Thomas Cox Ph.D RN, [2000] “Professional care giver insurance risk. A brief primer for nurses,
executives and decision makers, Nurse Leader 48-55.
Harold D. Miller [September – October 2009]. “From Volume to value: better ways to pay for
Healthcare” – Health Affairs, Project Hope.
Diagram of flows of a FFS Business Model
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12. Gnostam LLC January 31st, 2012 Newsletter
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Debt Explosion in US is not unique. See European experience in graph below, in
part because of unfunded liabilities in the public healthcare sector.
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13. Gnostam LLC January 31st, 2012 Newsletter
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Differening share of Profit and Labour 1947 to 2011
United States
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14. Gnostam LLC January 31st, 2012 Newsletter
PO Box 960
Inverness, CA 94937
Disclaimer:
The information and any statistical data contained herein have been obtained from sources which we
believe to be reliable, but we do not represent that they are accurate or complete, and they should not
be relied upon as such. All opinions expressed and data provided herein are subject to change
without notice. Gnostam LLC and/or its shareholders, directors, officers and/or employees, may have
long or short positions or deal as principal in the securities discussed herein, related securities or in
options, futures or other derivative instruments based thereon. The securities mentioned in this report
may not be suitable for all types of investors. ALL investments involve different degrees of risk. You
should be aware of your risk tolerance level and financial situations at all times. Furthermore, you
should read all transaction confirmations, monthly, and year-end statements. Read any and all
prospectuses carefully before making any investment decisions. You are free at all times to accept or
reject all investment recommendations made by the Gnostam LLC. As you know, a
recommendation, which you are free to accept or reject, is not a guarantee for the successful
performance of an investment and we are expressly prohibited from guaranteeing accounts against
losses arising from market conditions.
Past performance is no guarantee of future results, and current performance may be lower or higher
than the performance data quoted.
Investment Disclaimer All investments involve different degrees of risk. You should be aware of
your risk tolerance level and financial situations at all times. Furthermore, you should read all
transaction confirmations, monthly, and year-end statements. Read any and all prospectuses carefully
before making any investment decisions. You are free at all times to accept or reject all investment
recommendations made. All products sold are subject to market risk and may result in the entire loss
to the client's investment. (For example: excessive withdrawals may result in the depletion of your
account). Please understand that any losses are attributed to market forces beyond the control or
prediction of Gnostam LLC. As you know, a recommendation, which you are free to accept or reject,
is not a guarantee for the successful performance of an investment and we are expressly prohibited
Gnostam LLC
from guaranteeing accounts against losses arising from market conditions.
PO Box 960
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E-mail: pcorsano@gnostam.com
www.gnostam.com
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