1. Look at the sources below. They show changes which have taken place in an Italian village. Source A Livigno is one of the highest villages in the Alps. It used to be cut off during the winter. Nearly all the people in the village were poor farmers,

keeping cattle and sheep. Winter was the quiet season, with no money coming in. Livigno is now a popular skiing resort, with 40,000 visitors at times. Almost everyone in the village makes money from tourism.

Source B – Livigno in 2009

Old farm buildings sold for tourist accommodation

Livigno Shopping and entertainment centre

Cable car Road tunnel open all year

Chair lift Source C – Services listed on Livigno’s website in 2009 Trades Electrician Plumber Builder Mechanic Entertainment Bowling Cinema and theatre Clubs and pubs Restaurants and cafes Shops Accommodation Souvenirs Hotels Chocolates Apartments Perfumery Camping Hairdressers Ski hire Banks Sports equipment Jeweller

(a) Using the sources, describe three possible economic advantages for the villagers of the changes which have taken place in Livigno. 1

2

3

4 (b) Livigno is a popular tourist centre. From your own knowledge, give two possible environmental problems which popular tourist centres have to put up with. 1

Look at the source below. It gives information about plans to restart deep mining for coal in Scotland.

The coal produced in Scotland’s deep mines produces too much pollution. However, new technology means that this coal can now be used safely in power stations.

This means that power stations can now use the huge reserves of coal which still remain in Scotland. This deep-mined coal also causes less visual pollution than open-cast mining. Carbon emissions would be cut by 40%. The new technology would be cheaper than building new nuclear power stations and would reduce coal imports.

Marks KU EV 2. (continued) (a) Using the source, describe three advantages to the environment of the new coal technology.

4 (b) Deep mining and open-cast mining cause other environmental problems. From your own knowledge, give two examples of these other problems.

Look at the sources below. They give information about crimes against wildlife. Source A

A golden eagle has been poisoned in the Scottish Borders. It was one of the only breeding pair in the area. This means that no eagles will be raised in the Borders this year. The Royal Society for the Protection of Birds wants stronger sentences and wants police forces to appoint Wildlife Officers to catch offenders.

There are government plans to increase penalties for people convicted of wildlife crime. Gamekeepers could lose their gun licences and landowners would be heavily fined. However, farmers claim that eagles attack young lambs and kill grouse. One landowner said, “We need to earn money from grouse shooting. If these plans are passed, a gamekeeper could not do his job properly.”

Source B Numbers of poisoned birds in Scotland (2000–2006) Year Number 2000 145 2002 108 2004 154 2006 183

(a) There are plans to increase penalties for people convicted of wildlife crime. (i) From the sources, give two reasons for increased penalties. Reason 1

Reason 2

(ii) From the sources, give one reason agai

nst increased penalties. Reason 4

(b) Areas of outstanding natural beauty like the Scottish Highlands are often given special protection. From your own knowledge, give two reasons why these areas need to be protected. Reason 1

Look at the sources below. They give information about the development of an old farm on the Isle of Skye. Source A Before

After

Source B

Councillor Landowner

(a) Using information from the sources, give three ways in which the local environment will benefit from this development. 1

2

3 4 (b) Sometimes developments are referred to a Public Enquiry before planning decisions are made. From your own knowledge, describe what happens at a Public Enquiry.

INDUSTRIAL SOCIETY 5. Look at the source below. It gives information about home banking. Home banking allows customers to access their bank accounts at home on a computer. Source A

Customer

Customer

Union official

Bank director

Local councillor Source B – A bank advert

(a) “Home banking is good for our customers.” (Source B) Using the information in Source A, give three reasons to disagree with this statement. 1

2

3 4 (b) Banking is a service industry. Give one other example of a service industry, one example of a manufacturing industry and two examples of primary industries. Complete the table below by choosing from the following list: Forestry, Shipbuilding, Oil drilling, Police.

Type of Industry Service Manufacturing Primary Primary

Look at the source below. It gives information about changing employment in the Scottish Borders.

8000 7000 6000 Number of 5000 workers 4000 3000 2000 1000 0 1981 Key 1991 2001 2005 2009 Textiles Health and Social Services Agriculture and Forestry

Textiles Agriculture and Forestry Health and Social Services

(a) From the source, describe fully the changes which have taken place in employment between 1981 and 2009.

(You should mention the main trends and use figures in your answer.)

(b) Tourism is a growth industry in Scotland. From your own knowledge, give two reasons to explain the rapid growth of this industry. 1

Look at the sources below. They give information about unemployment and training.

Source A Persons unemployed for over 2 years

0

Source B Trainees on a government course were surveyed. The survey found that: • • 73% of trainees found a job.

However, half of them said that the training was not needed for their job. Trainees went on the course because they thought it would help them get a job. However, few of them felt that learning job-search skills actually helped them find work. The main reason for trainees leaving the course early was because they had found work. Many of the long-term unemployed lack confidence and are reluctant to join these training schemes. However, good training can help improve self-confidence.

(a) “Government training schemes for the long-term unemployed do not work.” Using the sources, do you agree or disagree with this statement? Tick (?) one box. Agree Disagree Give three reasons for your choice. 1

2

3 4 (b) Training schemes for the unemployed are very expensive. From your own knowledge, give two reasons why the government is willing to spend a lot of money on them.

Choose from the list below. Tick (?) the two correct boxes. Local colleges run training courses for the unemployed. The government gets taxes from people in jobs. The government gives cash grants to young people on training courses. The government has to pay out less in unemployment benefit. 4

SCOTTISH SOCIETY 8. Look at the sources below. They give information about living in urban and rural areas in Scotland. Source A • • • • • • The average price of a house in a rural area is £180,000.

The average price of a house in an urban area is £160,000. Workers in rural areas earn £25,000 a year. Workers in urban areas earn £30,000 a year. Holiday homes are usually found in rural areas. Holiday homes are charged less council tax.

(a) Using the sources, give three ways in which life for people in rural areas is more difficult than in urban areas. 1

(b) The population in Scotland’s rural areas has increased in recent years. From your own knowledge, give two reasons to explain why many people prefer to live in the countryside. 1

Marks KU EV 9. Look at the source below. It gives information about the languages spoken in Scotland in the past and the present. Scotland in 1100 AD Scotland in 2009

Key for both maps Gaelic speaking Norse speaking English speaking Gaelic and English speaking

9.

(continued) (a) The places where different languages are spoken in Scotland has changed since 1100 AD. From the sources, describe fully these changes.

Marks KU EV

4 (b) The Gaelic language is part of our Scottish cultural heritage. (i) From your own knowledge, give one other example of Scottish cultural heritage.

2 (ii) From your own knowledge, give one example of our Scottish cultural heritage which has been brought to Scotland by immigrants.

10. Look at the sources below. They give information about the level of support for Scotland becoming an independent country. Source A A survey of voters asked the following questions in 2005 and 2007. “Are you in favour of Scotland becoming a country independent from the rest of the UK?” The answers are shown in the graphs below. 2005 Yes No Don’t know 2007

Source B The Sunday Herald newspaper said that the 2007 opinion poll was “bad news for the SNP”. The SNP said it was “very encouraging”. Their spokesperson pointed out that many Labour, Liberal Democrat and even Conservative supporters said they were “in favour of independence”. The figures for the 18–24 year olds showed more than half in favour of independence, but the over-65 age group showed only 41% in favour.

Independence was less popular with women than men. In 1998, just before the Scottish Parliament was set up, opinion polls showed 60% of people preferring devolution and only 34% in favour of independence. Source C Support for the SNP in elections 1959 – 2007 (percentage of vote) 40 35 30 25 % of votes 20 15 10 5 0 1950 1960 1970 1980 1990 2000 Year Page twenty 2010

(a) From the evidence given in the sources,

which of the two options given below do you think will happen? Tick (?) one box to show your opinion. Scotland will become an independent country. Scotland will remain part of the United Kingdom. Justify your choice by using the information given in the sources.

4 (b) There are arguments for and against Scottish Independence. From your own knowledge, give two arguments for and two arguments against independence for Scotland. Choose from the following list. Put ticks (?) in the “For” or “Against” columns. For Scotland has been in the Union with England for over 300 years.

Scotland would control its own oil wealth. Scotland would be equal with other European nations. Scotland is protected by the British armed forces. 4 [END OF QUESTION PAPER] [0580/402] Page twenty-one Against

Healthcare industry

Part 1

The healthcare industry is a very competitive
industry and it does not look like that will change anytime soon. Competition
is a good thing for the healthcare industry. Competition provides a variety of

benefits which include, competition can increase the value or quality of care
given to the patient over time (Rivers & Glover, 2010). In addition, the
improvements in quality and value can decrease the delivery costs and other
healthcare-related costs (Rivers & Glover, 2010). The reduction of
healthcare costs is one of the key roles in healthcare competition (Rivers
& Glover, 2010). However, there are a variety of elements involved. Some of

the elements involved in healthcare competition include: quality, price,
technology, superior services or products, and convenience (Rivers &
Glover, 2010). In addition, to these elements organization’s compete for
physicians, patients, and third-party payers (Rivers & Glover, 2010).
Therefore, it seems that competition within the healthcare industry has the
potential for steady improvements and new treatment options for patients. Consequently,
organizations are constantly trying to “improve”

or “add
to” the current services and/or procedures offered.

Competition in the healthcare industry has impacted
the delivery of healthcare to the patient by, improving quality, containing
costs, and innovation (FTC, n.d.). There is competition among insurance
providers as well. Therefore, patients have the ability to “shop” for
the coverage they want to carry. This includes premiums, benefits, co-pays, and

deductibles etc… (Rivers & Glover, 2010). Patients also have the ability
to determine which healthcare provider they would like to seek services from
and browse through a variety of factors. A patient may want to go to one
healthcare organization because of its reputation even though the same services

are provided elsewhere cheaper. The increase in competition allows patients to
have more choices when it pertains to the care they desire or need.

Part 2

Competition is good for the healthcare industry. There are some benefits brought by competition, such as lower costs, better services for patients, and more innovation in healthcare management. In terms of services, healthcare providers can gain competitive advantage based on the services they offer. Faster services, such as same-day results for lab work, ultrasound,

and x-rays are appealing to patients. In addition, healthcare providers can gain patient popularity if they offer free consultations about medicine and healthcare. Healthcare quality and price of healthcare are the two most important factors considered by patients (Wall, 2013). Where real market competition can be found in healthcare, it drives quality upward and prices downward. Laser eye surgery and cosmetic surgery are both competitive markets;

in each, producers provide the information patients need, quality has improved, and inflation-adjusted prices have fallen.
In a growing trend in the healthcare industry, foreign hospitals are competing against hospitals in advanced countries that suffer under high prices or long waits for treatment. For example, Howard Staab from North Carolina had no health insurance when his doctor told him he needed open-heart surgery.

The Durham Regional Hospital said the procedure would cost $200,000. Instead, Staab flew to New Delhi, where a former New York University medical school professor performed the operation for less than $10,000 (Cannon, 2005). In this case, the patient had more options to choose healthcare treatments from different healthcare providers. Competition allows the patient to enjoy more low cost treatments in surgery.

Healthcare costs increase significantly in the past years. The reasons of increased costs include better technology, positive implications, increased insurance cost, and healthcare fraud. Healthcare fraud is an important and visible factor associated with increasing healthcare costs. Healthcare fraud cost the country an estimated $80 billion in 2012 (Jaeger, 2013). And it’s a rising threat, with national health care spending topping $2.7

trillion and expenses continuing to outpace inflation. The majority of health care fraud is committed by organized crime groups and a very small minority of dishonest health care providers (Jaeger, 2013). There are some types of health care fraud, such as billing for more expensive services or procedures than were actually provided or performed and performing medically unnecessary services solely for the purpose of generating insurance payments.

There are some reasons for healthcare fraud, such as the complexity of medicine, the ambiguity of the payment system, limited medical knowledge for fraud investigators (Otani & Baden, 2009). Healthcare system becomes complex: medicine becomes more technological; payment methods become more ambiguous;

health policies become more complex. Most patients know very little about medicine and they trust doctors. Because of that confusion, the healthcare industry is highly susceptible to fraud. The government should take more effort to prevent healthcare fraud. The federal government should create a National Fraud Research Center to be in charge of funding and performing fraud research throughout the country, and training all the FBI’s Fraud Investors. The Research Center could be funded by the money that is returned from fraud convictions.

Part 2

I think that the main reason that the United States healthcare system has suffered significant losses due to fraudulent activities, is due to the fact that healthcare managers have not been properly trained in detecting and preventing these activities. It appears that the level of training that these managers do receive, is being outpaced by the highly technical methodologies that are utilized by individuals that are committing fraud.

I also think that this problem can be solved by ensuring that managers are able to obtain recurring training concerning identity theft and its impact upon healthcare organization financial losses, as well as to ensure that all of the accounting and financial staff within healthcare organizations are well trained in detecting fraudulent activity. According to Gee, Button & Brooks (2011), “healthcare fraud is a challenging issue which has a direct and negative impact on human life, thereby leading to less funds availability to have a high quality patient care”.

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