Internal Audit Effectiveness Study on the Public Sector

Internal Audit Effectiveness Study on the Public Sector Agus Setiawaty Determinant of Internal Audit Effectiveness in Public Sector Organizations:  Which factors matter? Abstract Internal audit (IA) play a pivotal role in reinforcing good governance in both public and private organizations through a value-adding role. Yet very few research conducted on the IA effectiveness especially in public sector. The current study aims to examine empirically determinant of effectiveness of IA within organization. Effectiveness scale developed through structured interview with top manager before delivered to real participant. Data in this study collected through questionnaire given to top manager and internal auditor to explore participant perception on IA effectiveness and its determinants. Conventional multiple regression and path analysis is used to examine the association between internal audit effectiveness and four principal factors, namely; professional proficiency, quality of audit work, independence of audit internal department and top management support. Keywords: internal audit effectiveness, effectiveness scale, good governance, balanced scorecard INTRODUCTION Internal Audit (IA) facing higher demands in the line of duty. The role of internal audit now is not only overseeing the operational of organization activities, but has been extended to support the organization through evaluating and improving risk management, control and governance process (IIA, 2004). In this concept, the existence of internal audit is needed by management in order to help them to provide assurance that any risks in organization were identified and prevented effectively, and organizational activities has been controlled in effective and efficient ways. Moreover, Ridley (2008) declared that the construction of modern IA derived from the three Es concept namely effectiveness, efficiency and economy, which defined by as doing the right thing for effectiveness, efficiency describe as doing them well to describe efficiency and doing them cheaply for economy. Of all three factors, effectiveness is viewed as the most important factor because ineffective IA will ultimately cause to futile regardless how efficiently or economically the service is being provided. IA effectiveness is defined as a risk-based audit that support the organization to achieve its objectives through significantly influencing the corporate governance quality (Lenz, 2013). Effective IA is expected to encourage the formation of good governance within organization. The changing of IA role from compliance and safeguarding assets to value-added audit also impact that role in public sector organizations. However, some research findings (Mihret and Woldeyohannis, 2008; Cohen and Sayag, 2010) show that this role has not been effectively implemented in public sector organizations. In Indonesia context, audit findings issued by supreme audit board reveal that there is still problem relate to internal control in government institution although financial statement has been given unqualified opinion. These condition lead to the question about the effectiveness of internal audit function and further the related factors contribute to the IA effectiveness. The purpose of this study is to empirically investigate determinant of effectiveness of IA in public sector, an important concept rarely examined in the scientific literature. Most of previous study focused examining IA effectiveness empirically in the private institution (Cohen and Sayag, 2010; Arena and Azzone, 2009; Karagiorgos, Drogalan and Giovanis, 2011) while research on IA conducted in the context of the public sector has been done with a qualitative approach (Mihret and Yismaw, 2007; Mihret and Woldeyohannis, 2008), none has to conduct it empirically. To the best of our knowledge, there has never been a previous research which examines the determinants of the internal audit effectiveness in Indonesia context especially in public sector. Therefore, according to study of Cohen and Sayag (2010), this research will examine relevant factors to IA effectiveness with development in IA measurement using balanced scorecard framework proposed by Frigo (2002). This measurement claim to be more comprehensive in describing the effectiveness of IA in a organization than used in previous research. This study contributes to the literature by developing a conceptual understanding of IA effectiveness in public sector organizations using comprehensive framework of balanced scorecard which address fundamental issues influencing IA effectiveness in public sector context. This research also contributes to the literature by exploring the determinants of IA effectiveness. It is important to understand which factors determine IA effectiveness because of virtuous influence of effective to organizational performance (Mihret, James and Mula, 2010). This is a proposal paper, consequently, in the next section of this paper, the discussion address to relevant literature on IA Effectiveness and development of research expectation, followed by discussion of research methodology. CONCEPTUAL FRAMEWORK AND RESEARCH EXPECTATION The importance of internal audit function has been realized as an essential contributor to effective corporate governance and quality external financial reporting (Prawitt, Smith and Wood, 2009). The Institute of Internal Auditor (IIA) model offers IA as a key element of establishing high quality corporate governance, as well as management who principally responsible for regular monitoring of managements actions . As mentioned previously, The IIA has extended main function of IA to value adding focus by ensuring compliance to policies, rules, and regulations, which are largely of a financial nature, and by working in partnership with management to help improve operations and manage risk. Although the value-adding notion of IA is assumed shape the IA more effective, this is never guaranteed. In fact the literature suggests that IA effectiveness more influenced by the situational dynamics factor in audit environment (Mihret et al, 2010). Internal Audit Effectiveness As mentioned above, IA function has received greater attention according to its vital contribution to good governance, surely also occur in public sector context. Therefore, effective is needed for answering that challenge. There are two main approaches to the concept of IA effectiveness. The first approach associates effective IA with compliance to some set of auditing standard, such an approach proposed by Sawyer (1988) who assert five standard internal auditing, namely: interdependence, professional proficiency, the scope of work, the performance of the audit and management of the internal audit department. The second approach linking IA effectiveness with subject evaluations from management who act as supply side. In later approach, development of systematic and general valid measurement is needed to gauge IA effectiveness (Schneider, 1984; Dittenhofer, 2001). The early effort was conducted by Hoag (1981) through designing questionnaire to gain feedback about internal auditing pe rformance from management. The measurement of effective IA consist of planning and preparation, the quality of audit report, the timing of the audit, and qualify communication between the relevant parties. Study accomplished by Albrecht, Howe, Schueler and Stocks (1988) which sponsored by The IIA identified 15 factors contribute to the evaluation of IA effectiveness, such as the congruence between auditing work and the goal sets of managers, competence of internal auditor, support from top management to IA function, and several characteristics of IA department. More recently, Ziegenfuss (2000) developed a questionnaire which comprises 84 effectiveness criteria classified into four groups: the IA environment, input, process and output. Results of the study identified five top performance measures, that is: staff experience, supervision form audit committee, management expectation on IA function, audit recommendation followed up by management, and auditor education level. The development of effective IA measurement continue to evolve and sensitive to current issue so that Frigo (2002) introduced balanced scorecard (BSC) framework. For constructing the model, Frigo (2002) confirm his prem ises with BSC concept which built from IA customer perspective, internal audit process, innovations and capabilities. Model developed by Frigo (2002) will be presented next. This study modifies model proposed by Frigo (2002) to precisely adapt with public sector context. Modification is made to audit committee factor because its existence prevail in private institution. As noted before, research on the effectiveness IA is restricted to private sector companies while study in public sector have accomplished qualitatively. The current study takes this line of research a step further by designing and testing such a scale to gain understanding of IA effectiveness in public sector. Determinant of IA Effectiveness Determinant in this study adopted from the model proposed by Lenz and Hahn (2015) which divides effective IA determinant into micro and macro factors. However, this research largely focus the discussion in micro factor. Micro factor categorized into four factors: IA resources, IA process, IA relationship and organization. IA resources measured by staff professional proficiency (Prawitt, 2003; Cohen and Sayag, 2010; Mihret et al, 2010; Pforsich, Kramer, and Just, 2006,2010; Soh and Martinov-Bennie, 2011), IA process explained by quality work of IA department (Cohen and Sayag, 2010), while IA relationship and organization illumined by top management support (Halimah, Othman and Kamaruzaman, 2009; Christopher, Sarens and Leung, 2009; Mihret and Yismaw, 2007, Cohen and Sayag, 2010) and organizational independence (Mihret et al, 2010; Cohen and Sayag, 2010), respectively. Professional proficiency of internal auditor The IIAs Standards for Professional Practice of Internal Auditing require that internal auditors possess the knowledge, skills and expertise needed to accomplish audit work (Institute of Internal Auditors, 2008). Technical competence and continuous training are considered essential for effective IA. Consistent with this thinking, Gramling and Meyers (1997) found that certified internal auditors is perceived as an expert auditor which reflect auditors competence. Professional such as auditor requires a set of expertise in conducting their complicated duty that collectively granted from education, training, experience and professional qualifications (Al-Twaijry, Brierley and Gwillian, 2003). The few studies that concern to this issue indicated that the greater the professional competencies of the IA staff, reflected by their professional training and educational level, the more effective IA department (Albrecht et al. 1988). Nanni (1984) at the same ways, found that auditor experience positively impact the evaluations process of internal accounting control. Therefore, it es expected that Greater professional proficiency of staff within the internal audit department will be related to greater auditing effectiveness (H1). Quality of audit work Compliance with standards, policies and procedures is main concern of internal auditor. One of IA objectives is ensure that companys activities accordance with predetermined rules. Glazer and Jaenike (1980) in Cohen and Sayag (2010) asserted that audit work which sufficiently perform according to internal auditing standards contributes significantly to the effectiveness of auditing. The similar point also claimed by Ridley and DSilva (1997) that complying with professional standards is the most important contributor to IAs added value. It can thus be argued that greater quality of IA work -defined by compliance with formal standards, as well as a high level of efficiency in the audits planning and execution will improve the audits effectiveness (H2) Independence of IA department Independence has long been seen as a crucial factor in conducting audit role. Although initially only intended for the independence of the external auditor, but lately also addressed to the demands of the independence of internal audit, something that might be a serious problem because of auditor position and responsibility lay on under management. The independence of the internal audit department has been identified as a key element of audit effectiveness. Van Peursem (2005), based on interviews with Australian internal auditors, concluded that independence from management is a dominant feature of successful auditing programs. Those auditors able to set their own. It can thus be argued that organisational independence will increase the internal auditors effectiveness (H3). Top Management Support The interaction and relationship between top management and internal auditors is both important and complicated. Management support to IA is considered as a determinant of IA effectiveness (Mihret and Yismaw, 2007). This support could, for instance, be by allocating sufficient human and material resources to IA. It could also be by showing the level of cooperation offered by management. Greater level of auditee cooperation will influences the extent to which IA properly accomplishes its objectives (Al-Twaijry et al., 2003; Mihret and Yismaw, 2007). the relationship between the internal audit staff and the companys management is clearly important in determining the independence and objectivity of the internal auditor (Al-Twaijry et al. 2003;IIA 2006).Management support for IA is thus important both in the abstract (managers must see the activity of the audit department as legitimate) and in ensuring that IA departments have the resources needed to undertake their duty. Therefore, it i s argued that higher support from top management, the more effective the IA (H4). RESEARCH DESIGN The participants The target population for this study is managers and internal auditor from all Indonesian public sector organizations that conduct internal audit. Data in this study will be acquired through questionnaire which will be initially tested for validity and reliability before delivered to each participant. Each organization will accept two questionnaires, one for manager (deal with IA effectiveness) and the other for auditor (answering for independent variables). Variabel measurement Effectiveness of internal auditing Given the lack of IA effectiveness research in public sector organizations, this study will developed own effectiveness scale based on BSC framework proposed by Frigo (2002), supporting with measurement scale fostered by Ziegenfuss (2000). In this study, new effectiveness scale will be designed and adjusted with Indonesian auditing environment. Structured interview will be undertaken with several public sector top managers to gain advice and consideration about developed questionnaire before it comes to statistic analysis for the validity and reliability assessment. Independent variables Professional proficiency, measured by four indicators, consist of educational qualifications, professional certification, work experience and continuous development, Quality work, measured by six indicator, comprises of annual audit plan, access to all organization, significance of audit, auditee response, follow up action, additional activities performed. Independence, measured by nine items, these being: independence level, reporting level, direct contact to senior management, conflict of interest, interference, unrestricted access to all departments and employees, appointment and removal of the head of internal audit, and performing non-audit activity. Top management support, measured by four factors, those are: involvement in the internal audit plan, providing management with reports about the work the internal audit team performs, the managements response to internal audit reports, the resources of the internal audit department. Data Analysis Two methods of data analysis will used in this study. First, straightforward OLS multiple regression (Ghozali, 2013) was performed to estimate the magnitude of the effect of the independent variables, the four factors identified above, on the effectiveness of internal audit (the dependent variable). Second, beyond the straightforward use of conventional OLS multiple regression, path analysis (Ghozali, 2013) was conducted to investigate further the associations and linkages among the variables of interest. References Al-Twaijry, A.A.M., Brierley, J.A., Gwilliam, D.R. (2003). The development of internal audit in Saudi Arabia: an institutional theory perspective. Critical Perspectives on Accounting, 14 (5), 507-31. Arena M., Azzone G (2009). Internal audit effectiveness: Relevant drivers of auditees satisfaction. Sixth European Academic Conference on Internal Auditing and Corporate Governance. London. Retrieved from http://www.cass.city.ac.uk/__data/assets/pdf_file/0003/37335/Marika-Arena.pdf. Christopher, J., Sarens, G. Leung, P. (2009). A critical analysis of the independence of the internal audit function: Evidence from Australia. Accounting, Auditing Accountability Journal, 22 (2), 200-220. Cohen, A., Sayag, G. (2010). The effectiveness of internal auditing: An empirical examination of its determinants in Israeli organizations. Australian Accounting Review, 20 (3), 296-307. Dittenhofer, M. (2001). Internal auditing effectiveness: An expansion of present methods. Managerial Auditing Journal, 16, 443-50. Frigo, M.L. (2002). A balance scorecard framework for internal auditing departments (Paperback). The Institute of Internal Auditors Research Foundation. Altamonte Springs. Florida. Ghozali, Imam. (2013). Aplikasi analisis multivariate dengan program SPSS. Semarang: Badan Penerbit Universitas Diponegoro, Semarang. Gramling, A.A., Myers, P.M. (1997). Practitioners and users perceptions of the benefits of certification of internal auditors. Accounting Horizons, 11 (1), 39-53. Halimah, N.A., Othman, R., Kamaruzaman, J. (2009). The effectiveness of internal  audit in Malaysian public sector. Journal of Modern Accounting and Auditing, 5 (9), 53-62. Hoag, D.A., (1981). Measuring audit effectiveness. Internal Auditor, April: 70-8. Institute of Internal Auditors. (2004). Definition of internal auditing. Retrieved from https://na.theiia.org/standards-guidance/mandatory-guidance/Pages/Definition-of-Internal-Auditing.aspx. Institute of Internal Auditors Belgium (2006). Internal audit in Belgium: the shaping of internal audit today and the future expectations survey results. Retrieved from: www.iiabel.be/. Institute of Internal Auditors. (2008). International standards for the professional practice of internal auditing. Retrieved from: www.theiia.org/guidance/standards-and-practices/professional-practices-framework/standards/standards-for-the-professional-practice-ofinternal-auditing/. Karagiorgos, T., Drogalas, G., Giovanis, N. (2011). Evaluation of the effectiveness of internal audit in Greek hotel business. International Journal of Economic Science and Applied Research, 4 (1), 19-34. Lenz, R., Hahn, U. (2015). A synthesis of empirical internal audit effectiveness literature pointing to new research opportunities. Managerial Auditing Journal, 30, 5-33. Lenz, R. (2013). Insights into the effectiveness of internal audit: a multi-method and  multi-perspective study. Dissertation at the Università © catholique de Louvain Louvain School of Management Research Institute. Retrieved from https://drrainerlenz.files.wordpress.com/2013/03/2013-02-rainer-lenz-public-defense.pdf Mihret D. G., Yismaw A. W. (2007). Internal audit effectiveness: An Ethiopian public sector case study. Managerial Auditing Journal, 22 (5), 470-484. Mihret D. G., Woldeyohannis G.Z. (2008). Value-added role of internal audit: An Ethiopian case study. Managerial Auditing Journal, 23 (6), 567-595. Mihret, D. G., James, K., Mula, J. M. (2010). Antecedent and organizational performance implications of internal audit effectiveness. Pacific Accounting Review, 22 (3), 224-252. Nanni, A.J. (1984). An exploration of the mediating effects of auditor experience and position in internal accounting control evaluation. Accounting, Organizations and Society, 9, 149-63. Prawitt, D.F. (2003). Managing the internal audit function. IIA Research Foundation, Altamonte Springs, FL. Retrieved from: https://na.theiia.org/iiarf/Public%20Documents/Chapter%206%20Managing%20the%20Internal%20Audit%20Function.pdf Pforsich, H.D., Peterson Kramer, B.K., Just, G.R. (2006). Establishing an effective internal audit department. Strategic Finance, 87 (10), 22-29. Pforsich, H.D., Peterson Kramer, B.K., Just, G.R. (2008), Establishing an internal audit  department: The case of the Schwan food company. Global Perspective on Accounting  Education. 5, 1-16. Prawitt, D., F., Smith, J., L., Wood, D., A. (2009). Internal audit quality and earnings management. The Accounting Review, 84 (4), 1255-1280. Ridley, J., DSilva, K. (1997). A question of Values. Internal Auditor, June: 16-19. Ridley, J. (2008), Cutting edge internal auditing, John Wiley Sons, Ltd, Chichester, England. Retrieved from: http://www.gbv.de/dms/zbw/548154120.pdf. Sawyer, L.B., (1988). Sawyers internal auditing. Institute of Internal Auditors. Altamonte Springs, FL. Schneider, A. (1984). Modeling external auditors evaluations of internal auditing. Journal of Accounting Research, 22, 657-78. Soh, D.S.B., Martinov-Bennie, N. (2011). The internal audit function, perceptions of internal audit roles, effectiveness and evaluation. Managerial Auditing Journal, 26 (7), 605-622. Van Peursem, K.A., (2005). Conversations with internal auditors, the power of ambiguity.  Managerial Auditing Journal, 20 (5), 489-512.. Ziegenfuss, D.E. (2000). Measuring Performance. Internal Auditor, February: 36-40. Retrieved from http://findarticles.com/p/articles/mi_m4153/is_1_57/ai_62599893/?tag=content;col1.

Constructing Your Health Decisions

Constructing Your Health Decisions Technology has overcome the population and few people are aware of various health issues it has caused. By simply sitting in an office behind a computer can cause problem from our backs and eyes to our balance. Office workers are the most at risk, and experts say it is important we monitor our workplace health.This can be avoided by going for a brisk walk at lunch, a stroll around the office every hour, and checking our posture by standing with your heels and back against the wall and seeing how far back you have to move your head until it touches the wall too. Also the television is one of the most popular forms of media all over the world. It can enhance ones appearance to have the viewer intrigued and question themselves like â€Å"why can't I look like that†. Instead of getting up and going for a walk or hanging out with friends, television, has us caught up in our homes.Another major media downfall that influences one's health is the int ernet. Let's say I have symptoms of a common cold for weeks that does not go away, I can type in my symptoms on the internet and various options will come out. Now I can assume I have a major medical issue without even consulting with a doctor. A person has the responsibility of enhancing their health by choosing healthier foods and exercising more. They can choose to not be influenced by the media. Also by doing activities that Improve our self-esteem can lustily how we will portray ourselves to the world.

Seguro médico de viaje internacional para EE.UU.

Los turistas extranjeros no està ¡n obligados por ley a comprar seguro mà ©dico internacional para viajar a Estados Unidos. Sin embargo, carecer de cobertura mà ©dica en ese paà ­s puede causar consecuencias econà ³micas y migratorias muy graves. Puntos Clave: seguro mà ©dico de viaje para EE.UU. Costo medio visita a Emergencias: $2.168 dà ³lares americanosCosto seguro mà ©dico de viaje: a partir de $1.50Cà ³mo elegir el mejor seguro: Travel Insurance Center, SquaremouthProblemas migratorios: Cancelacià ³n de visa de turista o ESTA. Problema cada vez mà ¡s frecuente. Costo de gastos mà ©dicos en EE.UU. No cabe duda de que en Estados Unidos hay mà ©dicos y hospitales que son los mejores en su especialidad a nivel mundial como, por ejemplo, en el tratamiento de cà ¡ncer. Pero tambià ©n es la sanidad mà ¡s cara del mundo. Segà ºn datos del National Institute for Health, el costo promedio de una factura por asistencia mà ©dica en Urgencias de un hospital (ER, por sus siglas en inglà ©s), es de $2.168. Ademà ¡s, hay que tener en cuenta que el costo puede variar enormemente no sà ³lo segà ºn la naturaleza del problema de salud, sino que tambià ©n depende del tratamiento, de los anà ¡lisis practicados y del lugar en el que se reciben los cuidados mà ©dicos. Por ejemplo y segà ºn datos de International Insurance Travel Group, los gastos facturados pueden ser los siguientes: Dolor de cabeza: de $15 a $17.797Infeccià ³n de orina: de $50 a $73.002Piedra en rià ±Ãƒ ³n: de $128 a $39.408Consulta mà ©dica tà ­pica: de $150 a $200Anà ¡lisis de sangre: pueden llegar a costar $1.200 Recientemente varios medios de comunicacià ³n se han hecho eco de dos casos en los que una mujer recibià ³ una factura de $2.229.11 por tres puntos de sutura y un hombre de mà ¡s de $3.500 por cinco puntos, a pesar de que el costo promedio està ¡ entre $150 y $350. En esas cifras queda claro que los costes son altà ­simos y que dependen en gran medida del lugar dà ³nde se recibe el cuidado mà ©dico. El problema es tan grande que, de hecho, los costos mà ©dicos son la principal causa de bancarrota familiar en el paà ­s ya que tan solo en 2016 se solicitaron 770.846 segà ºn el National Bankkrupcy Forum. Los turistas internacionales visitando los Estados Unidos deberà ­an comprar un seguro mà ©dico antes de salir de sus paà ­ses para evitar tener que pagar ese tipo de gastos mà ©dicos por problemas que puedan surgir durante la visita.  ¿Cuà ¡l es el mejor seguro mà ©dico de viaje para EE.UU. y quà © està ¡ excluido? Un buen nà ºmero de aseguradoras que venden seguros de viaje internacionales excluyen a Estados Unidos de sus pà ³lizas por el alto costo de los servicios mà ©dicos en este paà ­s. Por ello es fundamental asegurarse de que el seguro que se quiere cubre Estados Unidos. Ademà ¡s, es altamente recomendable preguntar cuà ¡n grande es la red de mà ©dicos y hospitales en el paà ­s de la aseguradora, si està ¡ incluido un servicio de traduccià ³n si no se habla inglà ©s y tambià ©n de evacuacià ³n mà ©dica, ambulancia y repatriacià ³n. Una vez que esos puntos se han clarificado, lo que es el mejor seguro depende de las necesidades de la persona que lo contrata, de su salud e incluso de su edad. Tambià ©n de si prefiere pagar una cantidad alta y no hacer co-pagos o prefiere abonar una pequeà ±a y, si hay un accidente o enfermedad, realizar un pago junto con el seguro. Cabe destacar que en la mayorà ­a de los seguros para turistas que viajan a EE.UU. està ¡n excluidos todas ls enfermedades y condiciones pre-existentes entre los que se encuentran la diabetes, el cà ¡ncer, problemas de corazà ³n, etc. Ademà ¡s, con carà ¡cter general no està ¡n incluidos en estas pà ³lizas los gastos ocasionados por un embarazo, el parto, consultas genà ©ricas de cualquier clase, vacunas, exà ¡menes oculares o dentales y procedimientos cosmà ©ticos.  ¿Cà ³mo comprar un seguro mà ©dico de viaje para EE.UU? Se puede comprar cualquier seguro mà ©dico internacional que expresamente incluya Estados Unidos. A la hora de comprar es recomendable consultar con precios y condiciones de varias aseguradoras. Ademà ¡s, el seguro mà ©dico de viaje se puede comprar online en la pà ¡gina web de Travel Insurance Center, que està ¡ afiliada con USA Tourist.com y ofrece una gran variedad de seguros. Tambià ©n es recomendable verificar con Squaremouth y comparar entre cientos de seguros para ver cuà ¡l es el mà ¡s conveniente para cada caso. Tanto Travel Insurance Center como Squaremouth està ¡n recomendadas por embajadas y consulados americanos.  ¿Cuà ¡l es el costo de un seguro mà ©dico de viaje para EE.UU.? Hay una gran variedad de precios dependiendo de, entre otras cosas, quà © cantidad de cobertura mà ©dica se compra. Es prà ¡ctica frecuente asegurar entre $50.000 y $100.000 para viajes inferiores a tres meses y de $100,000 a $500,000 para estancias previstas superiores a un trimestre. Obviamente, se puede asegurar mà ¡s cantidad o, incluso, sin tope mà ¡ximo. Ademà ¡s de la cantidad asegurada influye en el precio del seguro mà ©dico el tipo de beneficios que se incluye y quà © se excluye, si hay co-pago cada vez que se utiliza el seguro, si hay deducible y la cantidad de à ©ste. El deducible –deductible en inglà ©s – es la cantidad de dinero que el asegurado debe pagar por un gasto mà ©dico cubierto por la pà ³liza antes de que empiece a pagar el seguro. Por ejemplo, si hay un deducible de $2.000 eso quiere decir que el asegurado debe gastar esa cantidad en recibir servicios y cuidados mà ©dicos antes de que el seguro comience a pagar. El deducible es diferente al costo del seguro, que se conoce en inglà ©s como premium, y debe pagarse en el momento en que se contrata el seguro. Teniendo en cuenta todo lo dicho en los pà ¡rrafos anteriores, el seguro mà ©dico puede costar entre $1.50 por dà ­a a mà ¡s de $10 por dà ­a, dependiendo de lo que se asegure. Es muy recomendable guardar facturas siempre si se acude a un mà ©dico o a un hospital. Ademà ¡s, en el caso de las medicinas la mayorà ­a de las aseguradoras siguen la polà ­tica de que el turista debe pagar por ellas y mà ¡s tarde le regresa el gasto, pero debe recibir factura que le debe enviar el asegurado.  ¿Dà ³nde recibir tratamiento mà ©dico barato en EE.UU.? Los tratamientos mà ©dicos en Estados Unidos pueden ser muy caros aà ºn estando asegurados porque, por lo general, la mayorà ­a de los asegurados deben pagar parte de la consulta o procedimiento. Por esta razà ³n es muy comà ºn que, salvo casos de emergencia, se acuda a centros econà ³micos y nunca a Salas de Emergencia de hospitales para asuntos como dolor de garganta, resfriados, infeccià ³n de orina, dolores de cabeza, etc. En Estados Unidos prestan estos servicios un abanico de centros, entre los que destacan las Clà ­nicas de Salud Comunitarias, las Clà ­nicas de Cuidado Urgente y las clà ­nicas Walk-in. Se puede consultar sus ubicaciones y cuà ¡l es la mà ¡s cercana en la pà ¡gina de la Asociacià ³n Nacional de Clà ­nicas Gratuitas y Caritativas (National Association of Free and Charitable Clinics, en inglà ©s. Por à ºltimo, cabe destacar que en cadenas como CVS, Walgreens o Walmart es habitual que brinden un servicio para rutinas mà ©dicas a cargo de enfermeros y asistentes mà ©dicos.  ¿Por quà © cuando un turista no paga una factura mà ©dica puede tener consecuencias graves? Los turistas, tanto los que viajan con visa como los que pueden hacerlo con ESTA, pueden sufrir la revocacià ³n de esos documentos y la prohibicià ³n de ingresar a Estados Unidos por no pagar un gasto mà ©dico. La razà ³n està ¡ en la Ley de Tratamiento Mà ©dico de Emergencia (EMTALA, por sus siglas en inglà ©s) que dice que los hospitales y mà ©dicos tienen la obligacià ³n de atender las emergencias de todas las personas que lo necesiten. Emergencia en EE.UU. significa, entre otras cosas, que no se haya ingresado al paà ­s para recibir ese tipo de tratamiento y que de no recibir el cuidado mà ©dico urgente la persona enferma o accidentada puede morir o sufrir un fallo de un à ³rgano o parte de su cuerpo. Ademà ¡s, para ser emergencia el problema debe haber surgido de repente, es decir, no puede ser el resultado de una condicià ³n previa debilitante. Como ejemplos de emergencias pueden citarse los partos, la amputacià ³n de una pierna o brazo, un ataque de apendicitis, etc. En estos casos de emergencia que el hospital debe atender si el enfermo o accidentado no paga o/y no tiene seguro mà ©dico el que acaba pagando es Medicaid, que està ¡ financiado con dinero de impuestos de los estadounidenses a travà ©s de aportaciones de los estados y de dinero del gobierno federal. Precisamente esto à ºltimo es lo que puede causar problemas migratorios de anulacià ³n de visa o ESTA y de no poder conseguir visas inmigrantes o no inmigrantes a partir de ese momento porque se puede considerar a la persona que no pagà ³ como una carga pà ºblica y, por lo tanto, inadmisible para ingresar a EE.UU. Puede tomar esa decisià ³n un agente consular o cualquier miembro de la CBP (Patrulla Pronteriza). Asà ­, puede darse casos como, por ejemplo, que una seà ±ora dà © a luz en EE.UU. como turista y a partir de ese dà ­a ingrese al paà ­s en varias ocasiones sin ningà ºn tipo de problema. Y de repente un dà ­a en el puesto de control migratorio se le niegue la entrada al paà ­s y se le revoque la visa o la ESTA por decisià ³n de la persona encargada en ese momento de checar los papeles. En la actualidad, à ©ste es un problema cada vez mà ¡s frecuente que afecta a unas personas pero no a todos, ya que depende de la decisià ³n personal de agente de la CBP o del consulado. En estos momentos no es posible saber con certeza ni quià ©n se va a quedar sin visa por esta causa ni cuà ¡ndo pero sà ­ que es una situacià ³n cada vez mà ¡s comà ºn. La CBP no ha notificado pà ºblicamente cà ³mo se entera de que una persona no pagà ³ una emergencia mà ©dica pero en algà ºn momento durante la emergencia mà ©dica se obtiene el pasaporte del turista, se escanea y se envà ­a a las autoridades en todos los controles migratorios en las aduanas. Ademà ¡s, en el caso de haber dado a luz a un nià ±o en EE.UU. los datos de ambos padres se obtienen fà ¡cilmente al solicitar el pasaporte estadounidense para el menor. Cada vez son mà ¡s frecuentes los casos en los que en ese momento se anula las visas de los dos progenitores. Ademà ¡s, destacar que à ©stos no tienen derechos migratorios mientras el hijo es menor de 21 aà ±os. Por à ºltimo, cabe destacar que ningà ºn hospital o mà ©dico atiende a turistas sin seguro o sin pago previo exceptuando ese caso de emergencia explicado en los pà ¡rrafos anteriores por lo que es altamente recomendable comprar un seguro mà ©dico de viaje antes de ingresar a EE.UU. Este es un artà ­culo informativo. No es consejo legal para ningà ºn caso en particular.

One of the Main Divisions Between Mainstream and Critical...

One of the main divisions between mainstream and critical social psychology is that of the methods adopted. Discuss with reference to the cognitive social and at least one other social psychological perspective. Social psychology has existed for about 100 years, before which psychology was a branch of philosophy. Social psychology studies individuals in their social contexts. It is a diverse discipline made up of many theoretical perspectives and variety of different methods are used in social psychological research. This assignment explores the main principles of different methods in social psychology. It will look at the underlying theories or perspectives that organise contemporary social and discursive psychological research†¦show more content†¦On the other hand, if social structures are overwhelmingly influential in individual action, people’s choices and desires would be irrelevant. Traditional social theory placed such emphasis on the power of social structures in governing peoples actions that this led to self determinism. A challenge for social psychology is to be able to understand the dynamic tension between desires and actions that are relatively free and ones that are heavily constrained by circumstances, rather than fall into assumptions on either side of the agency-structure binary. This interrogative theme will help us remain aware of dangers which, like individual-society dualism, have strong political and ethical implications. All of these interrogative themes are useful in evaluating social psychological research and theories. There are differences and similarities between the four perspectives on social psychology that have been defined in this essay. They all have reflexivity because the researchers are prepared to put themselves in the picture of knowledge production. 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