Preferred Provider Organization and Primary Care Physician free essay sample

HMOs first emerged in the 1940s with Kaiser Permanente in California and the Health Insurance Plan in New York. However, they were not adopted widely until the 1970s, when health care costs increased and the federal government passed the HMO Act of 1973, which required that companies that offered health insurance and employed more than 25 employees include an HMO option. The law also supplied start-up subsidies for these health plans (Barsukiewicz, Raffel, Raffel, 2010). Example: HMOs often operate on a prospective or prepaid payment system where providers are paid a capitated fee—one flat amount per beneficiary—per month, quarter, or year, regardless of the frequency or quantity of services used (Barsukiewicz, Raffel, Raffel, 2010). In staff model HMOs, such as Kaiser Permanente, providers are salaried, but this arrangement is the exception, not the norm. Example: In group policies, where health insurance is provided through the employer, the employer pays the insurance company a set amount agreed upon in advance. According to Austin and Wetle (2012), employers covered 83% of premium costs for single coverage and 73% for family coverage in 2009. The employee, or beneficiary, paid the difference. Then, the health insurance company pays the provider directly. Example: HMOs have the strictest access structure, called a gatekeeper model, where patients must have a primary care physician (PCP) through whom all care is routed. PCPs decide which diagnostic tests are needed and control access to specialists through referrals, deciding when it is necessary for a patient to seek more expensive specialty care (Barsukiewicz, Raffel, Raffel, 2010). Example: HMOs are usually the least expensive health plans, offer predictable costs for health care, the least administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, Raffel, 2010). However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring patients to see a provider in the HMO network, and often not covering more costly procedures or care options, because care is managed to control excessive or unnecessary care. Providers gain if they provide less care (Austin Wetle, 2012). This incentive could affect patient-provider trust. Example: Advantages of HMOs are that a known amount of revenue is guaranteed and the patient population number is fixed (Austin Wetle, 2012). In addition, if providers use less in services than the capitated fee, they are paid each month to cover the cost of care, they keep the difference. Conversely, if care costs exceed the contracted amount, then the provider must assume that financial risk, which puts providers at a disadvantage if they care for a sicker patient population (Austin Wetle, 2012). HMOs also restrict the covered services, which limits autonomy in medical decision-making. Indemnity In 1929 Baylor Hospital in Texas agreed to provide prepaid care at its hospital for approximately 1,500 teachers (Fox Kongstvedt, Chapter 1: An Overview of Managed Care, 2007). The teachers would receive 21 days yearly of hospitalization in return for the monthly sum they paid Baylor University Hospital. Blue Cross was later developed in the early 1930s to provide the same type of health insurance to other individuals for prepaid medical services. Indemnity plans are considered a traditional health plan due to the fact they were one of the first health policies in the United States. It is a fee-for-service plan as well. Once the patient receives medical care the insurer will then pay for the medical services rendered. With most indemnity plans there is an annual coinsurance maximum, and this amount varies depending on the plan. Once the coinsurance maximum is met, the insurer will pay 100 percent of the medical costs for the remainder of the year (Howell, 2014). There are three options available with an indemnity insurance plan. The first option is the indemnity plan where the insurer pays the insured a set amount daily for a maximum amount of days (Howell, 2014). The other two are both reimbursement plans. The second option is where the insurer pays a percentage of the insureds medical bill. This is typically 80 percent, and the insured is responsible for paying the remaining 20 percent. The third option is where the insurer covers 100 percent of medical care. For all plans, it is usually required to pay an annual deductible before the insurer will pay for any medical services. An indemnity plan is a non-network based plan with open-access. This allows the insured individuals to have flexibility with what doctor, hospital, or health care facility they choose. It is not required to choose a primary care doctor, and referrals are not necessary. Indemnity plans provide patients with flexibility and direct control over their medical care. They can visit a doctor of their choice and they are not forced to choose a primary care physician (Howell, 2014). If their favored physician is not part of a managed health care network the indemnity plan is better for them. There is additional paperwork that the patient will need to submit to be reimbursed for medical treatment. If the paperwork is not submitted correctly and in a timely manner there is a possibility of processing delays (Howell, 2014). Indemnity plans are the most expensive type of health plan. The patient is only reimbursed for services covered by the insurer, and all other services are to be paid in full by the patient. Because there is no set list of providers the patient must remain within, certain physicians may not have an agreement with the insurance company to provide care at a specific rate. The physician is able to receive the costs for services up front to guarantee they are getting what they charge. They may or may not help the patient with the required paperwork to submit for reimbursement. This saves the physician time and resources if they choose to receive funds in full before services, leave the paperwork to be handled by the insured patient. Consumer-directed health plan Consumer-directed health plans (CDHPs) were the result of public backlash against managed care and the rise in health care expenditures (Bundorf, 2012). CDHPs emerged in the late 1990s (Bundorf, 2012). They were intended to control costs by shifting responsibility for health care decision making from the insurer to the patient. Patients with CDHPs are required to pay for medical services rendered in a fee-for-service type payment plan. The patient pays for the costs out of pocket until the maximum out-of-pocket limit has been met. Once that limit has been exceeded, the insurance company will then cover additional costs. The insurer will reimburse the medical provider fully, or a portion of, once a claim has been submitted (AET). With a CDHP the patient is required to pay 100 percent of medical and pharmacy expenses at a discounted price for their plans contract until the yearly deductible has been met. For most plans the minimum for a single individual is $1,250, and for a family it is between $2,500-$3,000. Once the yearly deductible has been met, the patient will be required to cover a certain percentage of the cost for care received. The percentage varies based on whether the patient decided to see an in-network provider or an out of network provider, as well as who they have the CDHP with. Generally, if the patient stays in network they would only be required to pay for 10-20 percent of the total bill (Dow Corning, n. d. ). However, if the patient visit an out of network provider, they are required to pay 20-30 percent of their costs (Dow Corning, n.d). For some plans once the patient has met the deductible, the insurer will cover 100 percent of their in-network costs. With a CDHP the patient is required to pay 100 percent of medical and pharmacy expenses at a discounted price for their plans contract until the yearly deductible has been met. For most plans the minimum for a single individual is $1,250, and for a family it is between $2,500-$3,000. Once the yearly deductible has been met, the patient will be required to cover a certain percentage of the cost for care received. The percentage varies based on whether the patient decided to see an in-network provider or an out of network provider, as well as who they have the CDHP with. Generally, if the patient stays in network they would only be required to pay for 10-20 percent of the total bill (Dow Corning, n. d. ). However, if the patient visit an out of network provider, they are required to pay 20-30 percent of their costs (Dow Corning, n. d). For some plans once the patient has met the deductible, the insurer will cover 100 percent of their in-network costs. Patients with consumer-driven health plans are given a network of providers that their insurance company contracts with. The patient is not required to choose a primary care physician, and is not required to obtain a referral to see a specialist for medical care ( aetna, 2012). CDHPs can be beneficial to patients who have excellent medical risk profiles and will likely maintain in good health. It is also helpful for the patient to have a higher-than-average financial risk tolerance, otherwise medical care may be deemed too expensive and unobtainable (AscendUSA, 2012). Many patients do not utilize the resources available on their CDHPs website to compare costs and make the most of their plan. This can be linked to how little knowledge and direction patients are actually given on their plan (AscendUSA, 2012). Providers benefit financially when the patient pays for services up-front, before the maximum out-of-pocket limit is met. The services are covered almost immediately, rather than waiting for a claim to be processed and reimbursed. It is possible that CDHPs may cause distrust between the patient and provider if the patient begins to feel that their caregiver is taking advantage of them for monetary gain (AscendUSA, 2012). Point-of-service Point-of-service insurance plans are a hybrid of health maintenance organizations (HMO) and preferred provider organizations (PPO). In the 1900s point-of-service plans were introduced to allow patients insured with Blue Cross and Blue Shield more options with who should provide their healthcare, as well as flexibility to manage costs (Lichtenstein, 2013). Most providers within the point-of-service network are paid a capitated fee. They receive one flat amount per patient, regardless of services rendered. They also operate on a prospective payment system (PPS). The insurance company reimburses the provider an amount that is determined before the patient receive medical services. The patient is responsible for paying a co-payment or co-insurance up front before visiting with the doctor. Once the patient has been seen, the provider will submit claim forms to the insurer for the services rendered. Once the claims are processed the insurer will reimburse the provider (Austin Wetle, 2012). If the patient goes out-of-network, they are required to pay the provider in full for the services and then will be reimbursed by the insurer once they submit the claims. Point-of-service insurance plans have a gatekeeper role. This is the primary care physician for the insured individual. While the patient is not required to gain a referral from their primary care physician to seek medical care services from an out-of-network provider, it is strongly recommended. POS insurance plans try to encourage the use of referrals by making the patient endure higher co-payments and deductibles by choosing an out-of-network physician without referral. If the patient does receive a referral from their primary care physician the point-of-service plan will cover their expenses from services rendered (Small Business Majority, 2013). Point-of-service plans allow the patient t easily go out of the network to see any specialist. This is especially useful for outpatient medical services such as counseling (Gustke, 2013). The patient also has more geographic flexibility. If the patient were to get ill during a vacation, they could visit a care center and receive care. The choices are less limited, especially for those living in a rural area where medical choices may be sparse. The downsides include costly deductibles. Even when the patient remains within the POS network, a copay is required for each visit to the doctor. If the patient chooses to use an out-of-network provider, they may be required to pay a high annual deductible (Gustke, 2013). If the patient never uses an out-of network provider their premium money can be wasted. There is a lot of paperwork required for out-of-network care, and some providers require the fees to be paid in full before services are rendered. Reimbursements can take from three to six months (Gustke, 2013). Most POS plans require a referral, and this could be difficult to get as well as time consuming. When a provider gives medical care to a patient with point-of-service insurance, and they are an in-network provider, they will have additional paperwork to complete and submit on behalf of the patient for the services rendered. The provider will then have to wait until the claim is approved to receive their entitled money. Providers in-network are generally paid on a capitation basis, which may expose them to financial risk for services rendered (POS). Preferred provider organizations Preferred provider organizations (PPOs) began in the 1970s. There were created from, and to change, the rules of fee-for-service care. Preferred provider organizations are meant to encourage the insured to visit physicians and hospitals that have agreed to a predetermined plan as to keep costs down (Kiplinger, 2014). Preferred provider organizations negotiate a contract with providers, specialists, hospitals, and pharmacies to create a network. The providers in that network then agree on a set rate to provide health care services at a lower rate than they normally charge for services (Kiplinger, 2014). PPOs use a prospective and retrospective system. This is to ensure that the provider is only doing medically necessary tests and treatments for the injury being claimed, rather than trying to gain a larger reimbursement. In a preferred provider organization (PPO) the insured will pay a deductible to the insurer. Once the deductible has been paid, the insurer will then cover medical expenses incurred. Preventative care services are not subject to the deductible, however (Kiplinger, 2014). For some, the insured will also have a co-payment for certain services or be required to cover a percentage of the total cost for medical services rendered (BlueCross BlueShield, 2014). PPOs are the most common type of open-access plans. PPOs allow the patient to seek medical care with any provider they wish, whether in-network or out-of-network. The patient is not required to obtain a referral from their primary care physician, nor are they required to pick a primary care physician.

The Undisputed Truth About Essay Topics Atp That the Experts Dont Want You to Know

The Undisputed Truth About Essay Topics Atp That the Experts Don't Want You to Know The Supreme Approach for Essay Topics Atp They also include a number of cellular bodies called organelles. Included in these are ions, gases, alcohols, and little lipids. It's utilized via this complex to transport the protons back in the matrix. The complex is known as Acetyl Co-A. CoA is eliminated from succinyl-CoA to generate succinate. Within this process, one particular NADH molecule is generated. This says that glycolysis was involved in the development of life on the planet. Adenosine Triphosphate, regularly called ATP, is something which you want. The reason why it doesn't require energy is because it doesn't travel down a concentration gradient. There are 3 different kinds of transports for passive and two kinds of transports for active. There are two kinds of cell transport mechanisms. ATP powers all of the activity of muscles. The effect of the procedure is recombinant DNA. Since you may see, the process is everywhere the same. For instance, facial flushing is due to cutaneous vasodilatation. Furthermore centrifugation strategies, with a liver homogenate for a model is going to be addressed, creating fractions that are to be assayed for mitochondrial activity. The gene is understood to be the unit of inheritance. This is called a preparation reaction. In conclusion there are two sorts of cell transport mechanisms. By way of example, in college, you might be requested to compose a paper from the opposing standpoint. This also enables you to follow up on the advancement of your paper. If a student doesn't understand how to communicate properly, the paper may be tough to understand. We aim to supply quality papers that satisfy our clients. As tempting as it might appear to skip past the extra info and go straight to the list of persuasive essay topics, don't do it. You may find that a lot of the topics can be adapted to suit almost any sort of writing assignment. Quite frequently, the ideal topic is one which you truly care about, but you also will need to get well prepared to research it. Argumentative essay topics are so important since they are debatableand it's vital to at all times be critically considering the world around us. Because of this, the introduction ought to be brief, relevant to the subject, and need to have a thesis statement that gives a summary of the most important argument of the paper. English language classes usually call for a lot of writing. If you're looking for assistance with your essay then we provide a comprehensive writing service given by fully qualified academics in your area of study. Just take the time now to read more on the topic of persuasive writing. When it has to do with writing an argumentative essay, the most crucial matter to do is to select a topic and an argument that you may really get behind. A conclusion is, undoubtedly, the most significant portion of the argumentative essay because you can either support the excellent impression or destroy it entirely. However, the idea is to pick the most exciting argumentative paper topics as a way to impress both your audience and your teacher. Submitting this type of work ruins your probability of getting a great grade. Life After Essay Topics Atp Education scholars are continuously evolving the way that they think about how we learn and what's taught. Biology research paper topics demand a lot of research, analytical abilities, exemplary formatting abilities and appropriate mastery of the appropriate content taught in a standard classroom setting. This is an excellent practice for your communication and research abilities. Time constraint is a significant challenge that students face. Men and women argue fracking is a powerful approach to extract natural gas, but others argue it's too dangerous and is bad for the environment. Some men and women live their lives depending on their religion even though others don't think you should factor that into decision making in regards to determining rules for everybody. They need to demonstrate they can deal with the work competently. The issue is that everybody's interpretation of what makes a great society differs.

Letter From Birmingham Jail Essays - Gangs In The United States

Letter From Birmingham Jail Martin Luther King Jr.'s essay, A Letter From Birmingham Jail has become a classic for good reason. Martin Luther King was an excellent writer and speaker, appealing not only to the logical side of most people, but also to their emotional side. He was an intelligent man, keeping up with all the current events of not only the nation but the world, and was well read in issues of the past. What he said and wrote came from deep inside him and was influenced by his belief in God and Jesus Christ. His essay took his knowledge and his talents of persuasion, and summed up what he was working for and what he believed in. When he stated, "Anyone who lives inside the U.S. can never be considered an outsider anywhere within its bounds..." he was saying that Americans are people made up of many cultures and backgrounds. He was celebrating America's diversity, which makes the United States such a wonderful place to live. He would be ashamed and sorrowful if he saw how citizens of The United States treated each other today. If we had to take a million immigrants in, say, Zulus, next year, or Englishmen, and put them in Virginia, what group would be easier to assimilate? Patrick Buchanan is outspoken on many subjects, immigration is one of them. Buchanan believes that there should be a 200 mile fence built along the U.S. Mexican border, and that Congress should pass a five-year moratorium on legal immigration. He also feels that an Executive Order should be signed which would abolish federally mandated minority programs and affirmative-action plans, plans that were put in place during the Civil Rights Movement which King helped to lead. Buchanan is the same man who stated that women were "simply not endowed by nature with the same measures of single-minded ambition and the will to succeed." Yet, if he becomes President he will re-instate prayer and Bible study classes because he believes that family values and morals are non-existent in American society today. Is this guy for real? What happened to equality? How can someone be religious and still go around declaring that some people are better then others? Supposedly our country was to have gotten rid of all its racists notions during the 60's and the 70's. Apparently not. Buchanan is creating outsiders within the U.S. Measure 9 and Measure 13, measures, had they been passed, would have caused discrimination on a public scale, legal in Oregon. It would have isolated gays and lesbians as freakish groups who live their lives differently then the main stream, and therefore should be punished for their uniqueness. The founders of these measures, Lon Maybon and the Oregon Citizens Alliance, are so determined to pass such a measure that they are thinking of putting a third measure on the ballot next November. The OCA believes that they have the right to declare homosexuals as dirty people because it says so in the Bible. That, because they have intercourse with members of their own sex, homosexuals should not be allowed to adopt children, or to become legally married. That God has damned them for eternity and that they should be treated accordingly. The OCA is creating outsiders within the U.S. The Crips and the Bloods are two widely known gangs in America. They are centered in the Los Angeles area, but they have groups all across the United States in nearly every city. The Crips and the Bloods are only two of hundreds of growing gangs that are surfacing nation wide. The gangs are prominently located in the inner-cities, the poorer areas of large cities. The gangs play on the idea that they are a family. If anyone attacks my brother, then I'm here to fight back for him. Occasionally, they kill an innocent bystander or two. The kids (Kids they are. Gangs have been known to recruit children between the ages of 10 and 13.) that become members commonly have problems at home, abuse or neglect are prevalent. They feel that the only place left to turn is to the streets, and to the brotherhood of the gangs. Gangs are commonly associated with drugs and violence, for good reason. They attack each other for violation of territory and for interference in each others business, causing a vicious circle of revenge. The result of this violence is fear and anger felt by their victims and neighborhoods. It also leads to a separation between the inner-cities and the suburbs, and stereotyping of whites

Romanticism Nature Essay Topics

Romanticism Nature Essay TopicsThere are some romanticism nature essay topics that you might want to consider. They may not fit all your high school students, but most of them will be able to get a kick out of nature and forest fiction. Then again, it may not be appropriate for those in some of the more traditional subjects, and it may not be appropriate at all for some of the senior class. It really depends on what is appropriate for your students, and what they like.One of the most popular romanticism nature essay topics will be about the central mystery of the world, the Earth's environment. This has been known for a long time, and it is something that is still studied today. Most scientists and conservationists agree that it is a challenge that we must face if we want to preserve the natural habitats that we have. In addition, it is also something that we should be proud of and not try to 'hide from.'These romanticism nature essay topics usually go something like this: '... the p laces where nature has been hidden away, one need look no further than the deep forests, vast swamps, and deserts. Each of these places is full of wild life, and humans that depend on them to survive. Humans will never know how much they do not matter to their planet, and therefore, they must be taken care of.'It is said that the first ones that became extinct were the dinosaurs, because they no longer had any use for the energy that humans gave them. It is hard to believe, but it really is true. It would make sense, then, that when humans live near to nature, they do so with more respect, and with less of an influence over nature. In fact, the main reason that nature is protected is because of how it affects people, especially human health.Anotherromanticism nature essay topics will be that most parts of the world were given over to human use. Many forests were cut down, used for fuel, and for homes. Now that there are no more large game animals that can be hunted, many of these fo rests have become covered in thick forests of trees that are not healthy for anyone, but the very largest of animals. There is an imbalance of this in nature, and thus, protection of this has been needed.The very best romanticism nature essay topics are ones that involve the spread of cancer. This may seem rather over the top, but it is true. Not only does the spread of cancer to human beings hurt their own lives, but they hurt the animals around them.Cancer is not a fear that any one has, but it is a reality that needs to be addressed. Humans and animals alike will suffer from it, and it is true that it is an illness that will kill those who catch it. It is a disease that is often out of control, and by learning more about it, we can all help in stopping it.There are many romanticism nature essay topics that do not necessarily fall into the science fiction category. However, they can be very good if the topic can be demonstrated to be something that is out of the ordinary. Some may take a simple trip to the woods or a trip to the beach as a romanticism nature essay topic, but they may also mention the animals and the plants that are there.

Tips For Writing a College Essay About a Movie Review

Tips For Writing a College Essay About a Movie ReviewA college essay about a movie review is a good idea. But you should be sure to keep things within the parameters of academic fair. The following guidelines will help you make sure your college essay is legal and appropriate for a grade.The first thing you need to do is determine what type of essay you are writing. If you are going to use a movie review, you can choose any one or all of the following options. You can write an essay about the movie review itself, which uses the same format as a full-length paper would, or you can use the same options and write about the movie reviews themselves. There is a little more flexibility in the second option, since you will have more freedom to discuss how a movie has affected your own opinion of it.The next step in the process is to decide on a topic for your essay. Some college essays follow standard format rules, while others deviate from the norm. You want to create a formal article with a focused and well-constructed thesis statement. You want to come up with a topic that is closely related to the movie you are discussing. The essay's main purpose is to get the student's attention so that he or she will be compelled to complete it.Use specific examples when writing about a movie review. Don't just say something like 'I don't think Tom Cruise is an acting genius, but his movies are fun to watch.' You want to tell your reader why you think this, rather than just saying 'Tom Cruise is an acting genius.' While your essay may not include the specific statement you want, you will be able to cite examples of when Tom Cruise has displayed superb acting skills in one of his movies.If you are going to write an essay about a movie review, there are certain points you need to cover. Some of these points include: the producer or director, what kind of movie this is, the reason the film is good, the star's involvement, and any other relevant details. The primary focus of the es say should be on the topic.You need to present evidence about the movie. This means you need to use the standard sources, such as the press release, IMDB, DVD, and any other documentary evidence related to the film. You also need to include at least one citation, such as the website where you found the film, its Internet site, or its official website. Each of these cites should use proper spellings and phrases.Remember that a college essay about a movie review cannot be about what you think about the film, and it cannot have anything to do with your own opinion. Your review must be written as a result of your particular experience with the film. If you've watched the film in a theater, you cannot write a review about it.A college essay about a movie review can be as detailed or as simple as you'd like. Just make sure you keep these tips in mind so that you have the opportunity to be legal and successful. Good luck!

Topic For Video Game Related Research Papers

Topic For Video Game Related Research PapersIt is important to write a good topic for video game related research papers. While researching for the topic, you will be tempted to go ahead and post on forums and web pages about your research. There are some guidelines that you need to follow in order to make sure that the topic you wrote up is well organized and worth of your hard work.The first thing that you should do when writing about your research papers is to consider whether you should include all of the information that you want to include. You can include a brief introduction and background about yourself and the product of the research you have conducted. You can even include your proofreading techniques and your way of evaluating the results of the research. This is something that you should always keep in mind while writing. In case you want to make a more complete research paper, then you must ensure that you include every point that you want to.After you have included all of the relevant information, it is time to list them. It is vital that you list your research paper in order of importance to you. You can then go on to list your preliminary findings, the final findings, your conclusions and the recommendations that you can make. The last one is the area where you should include your essay.The topic for research papers are given by professors. The best time to write the research papers would be when you have completed a course or an internship that focuses on the topic that you want to write about. If you have not completed a research paper, then it is advised that you give it a year before you write one.In case you are having difficulties in coming up with a topic for your research paper, then you can go for your subject of interest. Usually, it is easier to write about your own interests. Another good option is to write about one of your favorite games. The reason behind this is that you can talk about your favorite games in a more personal mann er.One of the tips for writing good topics for video game related research papers is to avoid sharing your findings and conclusions with your friends. This is because it will be hard for them to understand your findings. Instead, they will understand it only after they have shared their ideas and perspectives. So, you should be careful in writing up your research papers.The topic for research papers that you will be writing can greatly influence the way that you will progress in your career. You can use the topic to improve your writing skills and you can also use it to further improve your popularity among the people.

Describe factors to consider for effective communication The WritePass Journal

Describe factors to consider for effective communication References Describe factors to consider for effective communication Describe factors to consider for effective communicationWRITEPASS CUSTOM ESSAY WRITING DISSERTATION EXAMPLESIntroductionReality vs. perception of realityThe formation of divergent perceptionsInterrelationship of the stagesNature of factors that affect perceptionReferencesRelated Describe factors to consider for effective communication WRITEPASS CUSTOM ESSAY WRITING DISSERTATION EXAMPLES Introduction When it comes to communication, the problem of perception takes the central stage. Varner and Beamer (2010, p. 35) defines communication as the perception of verbal and nonverbal behaviour and the assignment of meaning to them. They considered perception so important that as long as the perception process takes place, communication occurs. Covey (1992) also emphasised the significance of perception by attributing perception problems as one of the root causes of communication problems. Differences in perceiving the world would inevitably lead to communication barriers because people communicate on the basis of their own perceptions and perception determines how people behave toward the world (Singer, 1998). Therefore, great stress has been put on the role of perception in interpersonal communication that Singer (p. 10) even proposed in communication reality  ·Ã‚ ·Ã‚ · is less important than ones perception of reality. To discuss the crucial role of perception in communication, this essay first examines the relationship between reality and perception of reality, followed by a discussion on how perception affects communication in the stages involved. Finally, the role of three types of factors in perception physical, environmental and learned factors, will be examined. Reality vs. perception of reality Effective communication is hindered when communicators have different understandings of reality. Cognitive theorists are convinced that reality is more about the things in here in the mind, ratherthan the actual things out there (Singer, 1998). Perception, an active process by which people become aware of the world, is the window through which we experience the world .To illustrate the relationship between the two, Singer makes an analogy between the human perception process and a class assignment, both comparing and contrasting what enters and exits the mind (p. 187). Since it is impossible for a person to either experience everything in the world or have exactly the same life story as another person, no one will have absolutely right perception about the world or exactly the same perception as others. The fact that family members of twins can often easily tell one from the other explains that even twins do not have identical experiences and perceptions. The formation of divergent perceptions As Roger asserts, nothing, neither the Bible nor Freud, is more reliable than personal experience in the perception process (as cited in Griffin, 2006, p.32) . This supports Stacks, Hickson and Hills (1991, p. 4) suggestion that â€Å"Communication brings us together and perceptions tend to separate us.† Clearly, the impact of divergent perceptions in interpersonal communication has gain great attention of communicators. To reduce the difficulties in communication, it is necessary to understand how the divergent perceptions are formed in the first place. Perception is a series of procedures that blend into one another. To conveniently discuss the these procedures, perception is generally divided into three stages: selection/stimulation, organization, and interpretation/ evaluation (Lane, 2010; Kelly, 2006; Dwyer, 2009). The first stage is selection, in which the world comes to us through our sensory receptors. Naturally you cannot perceive everything; rather you engage in selective perception, where you pick up some stimulation over others. Two types of stimuli are considered more likely to draw our attention: meaningful ones and noticeable ones (Devito, 2009). Things meaningful or noticeable to one person do not often mean the same to another person. Therefore, during this stage, people of different backgrounds often receive different messages from the same world. For example, when a couple attend a concert, the husband, a musician, tends to focus on the musical part while the wife, a fashion designer, pays more attention on the costume and stage design. Suppose the design of the concert is excellent but the singer is off key from time to time. It is very likely that the couple end up having different comments on the concert. In this way, differences occur in the very first stage of perception proc ess. In the next stage organization stage, the stimuli that come into our brain will have to pass through the filters of our censor screens where they are rearranged and decoded in some ways we are used to or we learn to (Singer, 1998. p. 11) These ways of organizing data become the shortcuts that enable us to make connections between new information and previously gained knowledge, and thus simplify our understanding and remembering of new people and events. However, these shortcuts can be misleading if you rely on them too much. You may either add additional data which are consistent with your way of organizing or ignore those which is inconsistent, in order to make the new experience organisable. As the constructivists identifies, we often fit over realities to bring order to our perceptions (Griffin, 2006, p. 191). As a result, perceptual variations occur because we gain our perception not in the way it should be, but in a way every individual needs it to be. Having discussed the first two stages, we will now have a look at the third stage – interpretation/evaluation, in which we make sense out of the organised stimuli and find out the value of them. As Kelly (2006) suggests, we never have all the facts, and our interpretation and evaluation are largely dependent on the past knowledge and our own value systems. When personal experience and values are involved, differences are bound to occur. In other words, we get used to seeing some stimuli in a certain way that we dont take others into account (Lane, 2010, p.41). A good example of this would be stereotyping. When people stereotype others, they put people into categories and assert all people in the category share the same characteristics. The consequence is that barriers in communication often occur on the basis of false perceptions of others because great deal of individual differences are not taken into consideration (Lustig, 2010). The results of two studies of stereotypical p erception of African Americans show that African Americans are estimated to earn less than they actually do, are seen as poor and intimidating (Dixon, 2008) and are more likely to commit crimes (Ford, 1997). Many of stereotypes are created by direct experience with only a few members of a certain group. Others may even come from second-hand materials such as mass media without any direct experience. Yet many of us still use stereotypes to make assumptions and interpretations. This is very likely to cause communication gaps between people who perceive and expect others in their own understandings. Interrelationship of the stages Above is an analysis of how perceptual differences come into being in each of the stages. However, it is helpful to clarify, though listed in such a way, the three stages do not occur one by one. Rather, these stages often take place almost simultaneously (Lane, 2010, p. 36) and there is no way one can draw a dividing line between any of them. In addition, we should not see any stage as the start or the finish of a perception process (Russel, cited in Kelly, 2006, p. 36). It is common for people to think of these stages as a linear sequence, from gathering data to organizing the data and finally attaching some meanings to them. However, this process does not end at the interpretation stage because the result of interpretation/evaluation would affect your future sensing/selecting behaviour. In this case, some other ways of breaking down perception process would help make the point clearer. Initial three stages remaining the same, DeVito (2009, p. 64) believed two other steps take plac e afterwards: memory and recall. These two steps can lead to peoples perceptual inaccuracy in a way that people may lose or unable to recall some information. Even worse is retrieving the wrong message. Griffin (2006, p. 189) add a utilizing stage to emphasise the effect of memorized and recalled data on future communication behaviour. His suggestion of comparing the stages to the five interconnected Polemic Rings is extremely helpful in explaining the relationships of these stages of perception process (p. 187). Seeing the fact that the stages are actually interrelated and never come to an end, we can better know how we make mistakes when we think we see every aspect of an issue and make a right judgement. The truth is that previous interpretation has already had an effect on the selecting process, and we only pick up those data we want to, which further influence our organizing and evaluating process. For example: A person who experienced a destructive earthquake may notice a noise from the ground seconds before the shaking (Sensing stage). He then established a connection between the two: A noise often comes before a big earthquake and considered it a way to make predictions of future earthquakes (Organizing and interpreting). This interpretation inserts an influence on his future processing of information in the way that he may become very sensitive to similar sounds and more likely to link some other unusual phenomenon to an earthquake. From above we can see that differences take place in almost every step we take when perceiving the world. Just like what Ribbins and colleagues words said, the factors which shape and sometimes distort perception can reside in the perceiver, in the object or target being perceived or in the context of the situation in which the perception occurs (as cited in Dwyer, 2009, p. 14). These stages are like a giant filter, every information in the external world have to pass through the filter which is made of your own experience, beliefs and value systems (Bjorseth, n.d.). Again, similar to the analogy of class assignment described in the beginning of this essay, what exits your mind differentiate from what comes to your mind because your uniquely designed filter has performed its job. Nature of factors that affect perception Having identified how the factors impact on the perception process in each stage, the essay now focuses on the nature of the factors that affect perceptions. Singer (1998) has suggested three categories of them: physical determinants, environmental determinants and learned determinants. Physical determinant are commonly understood as our five sensory receptors recognized by Aristotle. Interestingly, Singer’s later research has revealed at least thirty-seven differentiate sensory inputs and even more are expected to be discovered (Singer, 1998, p.14). Apart from these, other physical differences such as body shape, skin colour, hand size that make us unique in the world can contribute to differences in perception. Just like every the uniqueness of individuals physical characteristics, everything happens in a unique context. The unique surroundings of an event can be very powerful in forming different perceptions. For example, the result of judging whether a person is young or o ld will probably be influenced by which age group he is compared with. The third type of determinants, learned determinants, is seen as the most important. How people acquire their perceptual constructs has been thoroughly studied. The result of an experiment on people who are born blind but later restored with their sight shows that without the visual experiences, these people cannot tell a figure or discriminate simple shapes until several months visual learning (Perception – Innate and learned, n.d.). This reveals that learning experience is necessary and powerful in shaping and changing peoples perception. Similarly, in Varner and Beamers (2010) perception model of choices, they explain that when you encounter something unfamiliar, you either choose not to attend to it or lose memory of it until you learn how to change your mental category to accommodate it. Singer (1998, p. 19-27) also devised an exercise to test how perceptions of the same stimuli differ in different cultures. The exercise finds out that perception is greatly influenced by culture, a combination of learned activities. The more specific the symbol is, the more the interpretations are alike. The more abstract the symbol is, the more various meanings are attached to it. With such findings, it is not difficult to understand that communicators from different cultures would undoubtedly meet difficulties with the different views they hold on the same thing. From the discussions above, we have seen that misperceptions can arise when we collect information, organise it in different ways, and assign different meanings to it. In addition, differences of perceptions are determined by various factors, especially learned ones. Communications based on divergent perceptions will inevitably meet difficulties. To make communication of higher level of effectiveness, it is a good start for communicators to bear in mind the powerful influence of different perceptions on communication process, to learn the culture of other groups and to make your perceptions closer to each other. References Bjorseth, L. D. (n.d.). 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