Pay-for-Performance and Reimbursement - Free Essay Example

Sample details Pages: 5 Words: 1598 Downloads: 6 Date added: 2017/06/26 Category Health Essay Type Argumentative essay Did you like this example? Pay-for-performance and Reimbursement are the important component of all healthcare organizations. Devoid of flow of money into the system of health care, it is tough to pay for the individuals offered services. Client has to shell out for the services of health care used by them. System of Health care is increasing on a quicker pace than the United States economy. The diverse reasons are proliferation of technology, new medicines in business, and advancements in devices, research studies, and novel procedures. Conversely, there are extensive concerns regarding the medical mistakes, incoherent eminence in health care services, raise in cost, and public knowledge regarding the health care services in the course of Medias, lead to the pay-for-performance movement. This materialized as a program of cost containment. System of Health care is endeavoring to offer efficiency, quality, transparency and accountability, in health care services in the course of the growth o f pay-for-performance movement (Henley, 2005). Pay-for-performance is referred to as program of financial incentive that pay a additional benefit to the partaker of services for instance hospitals, physicians, physician groups, or groups of health plan who accomplish a standard in efficiency, quality, responsibility in patient care and health care services. This is described as the program of pay-for-performance. This program offers high credit additional benefit for preventive care services. As the term indicates, pay-for performance is the high quality for services of health care for the money compensated by patients. It is an expression extensively used and utilized more and more throughout the execution of Affordable care Act. This plan offers incentives to the providers of health care to decrease the avoidable health care cost, and enhanced eminence of services. The additional names utilized for pay for performance comprises knowledge and skill based pay, merit pay, or group or individual incentive pays. Pay-for-Performance and Reimbursement Medicare offered a new financial model which aids to enhance the efficiency and quality with sufficient reimbursement for the doctors. The physician has no choice since of the increasing health care cost at a record speed and the quality of care remaining the same, an innovative system offered in which the medical doctor obtains rewarded for the quality of health care services he offers. Pay-for- performance nationally is a important plan in which the physicians group, hospitals, physicians, and providers of health plan are getting occupied into this movement ever since two decades. The reimbursement of money is based on more than a few measures. This comprises à ¢Ã¢â€š ¬Ã…“process measuresà ¢Ã¢â€š ¬Ã‚  founded on clinical quality and patient care improvement. The subsequently stride is à ¢Ã¢â€š ¬Ã…“outcome measuresà ¢Ã¢â€š ¬Ã‚  that offer information on how health care is influenced by patients. à ¢Ã¢â€š ¬Ã…“Structural measuresà ¢Ã¢â€š ¬Ã‚  review the long-term training, the organizational structure of delivered care and the health care services provider certification. An additional significant measure is the à ¢Ã¢â€š ¬Ã…“patient experienceà ¢Ã¢â€š ¬Ã‚  measure, in which the satisfaction of patients in the direction of care delivered gets assessed. Significant utilization of technology of health information is a prominence of program of pay-for-performance in which practice of evidence based, conveys changes in executing patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s health care. Quality Incentive Program reimburses bonus for the medical groups who carry out at or over 75th percentile on one or five of the measures of clinical quality, from the previous year. This incentive acquires paid on a basis of quarterly (Purcell. 2005). Pay-for-performance stoutly supposes that reimbursement can source a change in healthcare providerà ¢Ã¢â€š ¬Ã¢â€ž ¢s quality of care and behavior. A payment of bonus founded on a fraction of all delivered care by the provider acquires promoted. The payment of bonus for each patient for all services with a measure pre-determined provides the quality of care. A fraction of cost savings attained in relation to what cost would have been with high eminence of care. These are the diverse reimbursement sections in the program of pay-for-performance (Mayes Walradt 2011). Impact on Quality and Efficiency Impact on the efficiency and quality of care is computed in expressions of clinical objective and non-clinical objectives measures. The clinical objective is measured in expressions of the short term goals, process of care, transitional outcomes, and long-term objectives. Clinical goals offer improved accountability, and excellence of care when evaluated to the performance of provider. The eminence of care comprises decrease of medication mistakes, underuse and overuse of resources, and as well lessen inefficiencies and waste in the heal th care system. Appropriate precautionary health care service endorses patients health, decreases on the whole cost of care, and endorses positive admission to health care. The non-clinical objectives assist to enhance the effectiveness in health care services comprises increased access to health care services, electronic health records, and patient satisfaction. Employ of information technology helps in precise collection of data and reasonable reporting with methodically sound measures for instance evidence based practice. Electronic health records assist to access clinical outcomes online that averts replication of tests and enhances communication amid professionals of health care. Satisfaction of Patient survey provides information for potential development (Henley, 2005). Impact on Providers and Customers Pay for performance is an important administrative respite for the providers from the bureaucratic obstructions to treatment. With elevated performance in patient care, and the utilization of the wide release of information in the course of information technology, the eminence of care for clients acquires to be ensured. The consumers are capable to access the providerà ¢Ã¢â€š ¬Ã¢â€ž ¢s information, and regarding the eminence of services provided. Providers are capable to provide quality care with the employ of uniform measures, and recommendations for patient safety. A bonus payment for the provided services is extra savings for the health care providers. Chronic care Reimbursement and healthcare management for clients will offer hospital and physicians, with a minute amount of payments. The rewards of non-financial comprise helping patient to design and network providers which can compel the business with a high performing providers group. Additional status includes improved patient volume, recognition in community, and reputation role in the midst of the high performing providers. And also Compliance on quality, safety, and conformity with the u tilization of evidence based practices is an additional advantage for provider from the organizations of regulatory. Global changes in result measures for instance preventable hospitalizations, readmissions of inpatient, and decrease in the visits to emergency room. The satisfaction of customer improved with quality of care, decrease in cost and customer association in care. This program promotes patient-physician connection, self-management, stress on preventive features of care, and a variety of programs of support group for chronic clients. Public reporting allows customers to acquire information on the high performing healthcare providers and finest established practices (Geoffrey, 2003). For customers by executing pay-for-performance, the improved clinical outcome measure will be the concluding results. Effects of Pay-for-performance and Future The pay for performance requires research data to sustain advancement in the quality of care and also its potential benefits. If quality turn out to be the vital for the financial success, providers will move additional resources to the improvement of quality in a setting of health care. An additional challenge is in the direction of measuring the quality of physicianà ¢Ã¢â€š ¬Ã¢â€ž ¢s practice, for which quantitative and qualitative data is required to recognize their standards and methods of delivered care. Originally the pay for performance was instituted to reduce the cost of health care at the present the spotlight is in the direction of the quality. Simply one third of the study reveals savings in cost. As regards 90 percent of the score comprises the performance of adequacy and access measures. Merely 10 percentages is on national safety measures in which the data is manually entered. Future spotlight should be made on the reduction of cost by enhanced quality of care with novel measures, and new levels to measure. Pay for performance must drive forward into an age of value-based purchasing (Bhat Bha t 2012). In pay for performance the diverse areas of improvements comprise performance management in which the objectives must be reinforced, advance feedback and education for appraisal and development, and hold managers responsible for the outcomes and budget. I also includes placing goals and determining progress amid rewards and results. Center for Medicare and medical services must provide rules on the procedures and timeliness for a longer stay in hospital when waiting for admission. Lastly, information and education is the vital for the success of any program. No one can manage an innovative program devoid of employeeà ¢Ã¢â€š ¬Ã¢â€ž ¢s information and support. Encourage employeesà ¢Ã¢â€š ¬Ã¢â€ž ¢ participation in safety, quality, and performance improvement (A compelling case for a robust pay-for-performance future, 2004). Financial incentive simply is inadequate to compel hospitals in the direction of pay-for-performance program. To be thriving Center for Medicare an d Medicaid Services (CMS) must offer tools to health care providers, hospitals, and physicians on cost, quality, and operating costs. By carrying out research on a series of outcomes, assists to sort the associated trade-off with performance connected pay. On the other hand strong nursing care with education on precautionary features will fetch change in delivered quality of care which offers a smooth evolution towards program of pay-for-performance (Baker, 2003). Reference IOMAs Pay for Performance Report, (2004) A compelling case for a robust pay-for-performance future 04(11), 5 Retrieved from https://search.proquest.com/docview/230540767?accountid=458. G. Baker, (2003). Pay for Performance Incentive Programs in Health Care. Retrieved from https://www.leapfroggroup.org P., Bhat, J. Bhat, (2012). Tackling pay-for-performance: current and future challenges. Nephrology News Issues, 26(1), 27-29. E.Henley (2005). Pay-for-performance: What can you expect? Journal of Family Practice, 54(7). R., Mayes, J. Walradt, (2011). Pay-for-performance reimbursement in health care: Chasing cost control and increased quality through new and improved payment incentives. Health Law Review, 19(2), 39-43. F. Purcell, (2005). What is pay for performance? AANA Journal, 59(5), 15-17. Don’t waste time! Our writers will create an original "Pay-for-Performance and Reimbursement" essay for you Create order

The Division Of Gender Roles - 844 Words

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Safety Management Practices and Safety Compliance †Free Samples

Question: Discuss about the Safety Management Practices and Safety Compliance. Answer: Introduction Nearly all, if not all occupations are associated with some kind health effects also called occupational health hazards. Therefore, human resource managers recommend health surveillance as a method of detecting the potential health hazards that workers in such occupations may be exposed to. According to Arcury et al (2012), an early detection of these health hazards enables the implementation of interventions that facilitate the prevention of any possible disease that the workers may be exposed to, or a reduction of the speed with which a disease process may occur among the workers. This essay aims to identify appropriate health surveillance for workers exposed to Silica in a mining quarry which currently employs less than 20 individuals. We acknowledge that while the mining quarry has established certain measures (fogging systems, localized ventilation, and conveyor covers) to suppress the amount of dust the miners are exposed to, the workers are still exposed to a high risk of con tracting respiratory diseases associated with silicon from the crushed rocks. Our main objective is to design a health surveillance measure for workers in the quarrys control room. In doing so, the paper will first identify the health issues that the miners may be exposed to, before identifying a typical surveillance measure and designing an health surveillance for them. The paper will also give a detailed timeline for the implementation of the designed health surveillance measure before making recommendations on the health surveillance issue. While exposure to silica is a major health risk for miners in Australia, there is a paucity of knowledge of what entails proper health surveillance for such workers. Yet, Burgel et al (2013), Chalupka et al (2013) and Grabinski (2015) provide evidence of an increasing trend of Australian quarry miners contracting silicosis. Equally, statistics from Safe Work Australia and Australian Institute of Occupational Hygienists (AIOH) indicate that work-related injuries have high-cost implications to the Australian economy, and occupational hazards related to the mining industry have a significant contribution to the cost (Gochfeld et al 2007). From time immemorial, miners exposed to silica have been burdened by occupational health issues, with some of them dying from silicosis a disease caused by a formation of scar tissue in the lung as a result of constant exposure to silica (Hicks et al 2016). In fact, Hong et al (2012) claim that silica has dangerous effects comparable to asbestos and that it has a potential of causing serious health effects to miners in Australia. Against that backdrop, there is a need for mining organizations to identify and establish standardized health surveillance among workers exposed to silica so that they keep their workers safe. Similarly, Hood et al (2007) argue that there is a need for such organizations to consider establishing modern health surveillance approaches since there is a consistent change from historical models of risk surveillance to more modern and effective models. Keeping up with new techniques will facilitate a change from passive approaches to more active approaches to health surveillance (Junaid et al 2016). Respirable Crystalline Silica (RCS) A major component of granite, sand, rock, soil and other minerals found in the earths crust, crystalline silica dangerous substance consisting of silicon and oxygen (McCillagh et al 2012). The author further comments that silica may exist freely or combined with other elements to form silicates. On the same note, McCauley et al (2012) indicate that the three common types of crystalline silica (tridymite, cristobalite, and quartz) produce dangerous particles when ground, drilled or cut; and that exposure to these particles (especially during mining) is a major health hazard. In Australia, exposure to RCS has been assigned a safety limit of 0.1 milligrams per cubic meter (0.1mg/m3), meaning that an exposure beyond that limit would be considered a health hazard (Maghsoudipour Sarfaraz 2011). While some scholars claim that this limit is low, Pak et al (2013) observe that part of the reason why the limit was set at that point is the declining incidences of silicosis in Australia. However, the author mentions that despite a decline in incidences of silicosis in Australia, exposure to RCS generally has adverse health effects on most Australian miners. All in all, considering our case study, an RCS exposure of 0.15mg/m3 for primary operators and 0.51mg/m3 for secondary operator indicates a high health hazard which needs immediate attention. Silicosis is part of a group of dust-related diseases called pneumoconiosis, majorly characterized by non-malignant and non-neoplastic changes in lungs as a result of exposure to inorganic dust such as asbestos, coal dust or RCS (Rogers et al 2014). Reports by Health Grove indicate that Silicosis cause 1 death per 100,000 people yearly in Australia and an annual loss of healthy life at the rate of 9.4 people per 100, 000 people (Rogers et al 2014). A majority of Australian population working in the mining industry are exposed to silicosis and other RCS related diseases. Similarly, there are reports that a significant section of Australian population serves this industry. For instance, according to the estimates of the Mineral Council of Australia, there are 200,000 indirectly employed and 127,000 directly employed people in the mining industry (Smith Deloy 2014). Hence, while Subramaniam et al (2016) may have observed a general decrease in silicosis-related deaths in Australia, it is still a disease that affects to several Australians every year. Silicosis affects human health through a definitive pathophysiology, where deposits of RCS in the lung interstitium damage the lungs epithelial cells and release various inflammatory cytokines (interleukin-1 and tumor necrosis) and enzymes. According to Savinainen Oksa (2011), these inflammatory cytokines attract other inflammatory cells such as neutrophils, and macrophages which have a potential of damaging the lung parenchyma. Equally, Siddiqui et al (2011), Taormina et al (2013) and Walker (2013) propose that even an exposure to low doses of silica may lead to the inability of a worker to have their lungs cleared of inhaled dust, a condition which results from hilar lymph node fibrosis. When the lung parenchyma of a worker is exposed to collagen nodules and hyaline as a result of constantly inhaling silica, the worker may be susceptible to either complicated or simple silicosis. According to Steiner (2011), complicated silicosis is a radiology definition of a situation where the workers x-ray results show coalescent fibrosis while simple silicosis is where there are no signs of coalescent fibrosis. According to James et al (2014), silicosis is identified a common problem to miners majorly because complicated silicosis normally contributes to the development of other significant health complications such as respiratory disability and breathlessness. Equally, Al Amiry (2015) claims that while it is not proven that complicated silicosis leads to the formation of other lung-related complications such as lung cancer and tuberculosis, they are normally perceived as additional complications among persons with silicosis. Chronic Obscure Pulmonary Disease (COPD) A typical complication with COPD is a largely irreversible and lowly developing obstruction of a victims airflow. While cigarette smoking is regarded as the main cause of this complication, Groenewold Baron (2013) and Hong et al (2012) agree that exposures to silica as an occupational risk may also be a cause. Similarly, there are several studies supporting RCS as a causative agent of COPD. For instance, a meta-analysis by Arcury et al (2012) reveals that exposure to silica dust had a positive correlation with COPD. The meta-analysis involved 13 cohort studies that were conducted among coal miners. Apart from the observation that the miners were at a high risk of contracting COPD, the risk was discovered to be higher if the miners were smokers. A recent review by the United States National Institute of Safety and Occupational Health (NIOSH) revealed pathological and epidemiological evidence suggesting that constant exposure to RCS may cause airflow obstruction as a result of chronic small airways disease or chronic bronchitis (Chalupka et al 2013). Similarly, according to the author, the study revealed that emphysema was a predominant complication associated with obstructed airflow as a result of exposure to RCS. Hence, we can summarise that RCS can cause chronic bronchitis or emphysema which can result in airflow obstruction. A review of studies in the Britain on the evidence of increased exposure to COPD in industries and occupations such as tunnelling, cement production, ceramic production, pottery and steel and iron founding, and gold mining found that a consistent exposure to silica in these kinds of environments exposed the workers to COPD as a result of silica exposure (Chalupka et al 2013). RCS is also said to be a causative agent of rheumatoid silicotic nodules which are often found on the lungs of miners and are a risk factor for lung cancer (Gochfeld et al 2007). Similarly, according to Hicks et al (2016), the International Agency for Research on Cancer (IARC) reveals RCS as a potential carcinogen for human lungs, although there has been a major debate whether silica rather than silicosis is the most important causative agent for lung cancer. Other major health complications associated with RCS include renal and autoimmune diseases. Similarly, according to Burgel et al (2013), RCS has largely been reported to have a causative relationship with systematic lupus erythematosus, sarcoidosis, scieroderma and rheumatoid arthritis. Typical Risk assessment and health surveillance for RCS A typical way of conducting a risk surveillance of RCS exposure is through a measurement of the airborne concentration. According to Hong et al (2012), this method is appropriate because RCS only becomes a health risk when it is inhaled. Hence, In Australia, the most common methodology of conducting a surveillance of RCS health risk is air-monitoring. This a technique used to measure the particle size of RCS as an occupational health risk. According to Hicks et al (2016), these particle sizes are sampled and defined by AS 2985 (2004) which is a protocol established by ISO 7708 of 1995 for the same purpose. Based on AS 2985 of 2004, a respirable dust is defined as the portion of airborne materials which penetrate to un-ciliated airways when inhaled. In Australia, air-monitoring and analysis are carried out using X-ray diffraction or infrared spectroscopy as guided by the National Health and Medical Research Council (Chalupka et al 2013). According to Burgel et al (2013), a procedure that involves modern analytical instruments operated by a professional would take 8 hours per 8-hour work shift before an acceptable level of certainty over the RCS concentration is achieved. Similarly, Arcury et al (2012) argued that if a test process would last way shorter than 8 hours, for example, 4 hours or below, then the results may fall short of the legally set standard of proof of interference. However, any test that lasts longer than 4 hours is capable of providing proper compliance monitoring indicators and monitoring of concentrations (Gochfeld et al 2007). Nevertheless, according to Arcury et al (2012), the Australian Institute of Occupational Hygienists (AIOH) recommend a fully 8-hour sampling or a 12-hour for 8 hours and 12 hours work shift respectively. Similarly, the AIOH strongly recommends laboratory equipment accredited by the Australian National Association of Testing Authorities (NATA) for use in the RCS surveillance and analysis. Health Surveillance Measures Upon conducting the monitoring and assessment, the organization can choose to control the exposure levels by drafting an action plan to help eliminate the amount of dust the miners are exposed to (Junaid et al 2016). However, according to Arcury et al (2012), this should be after inviting an occupational health professional to conduct health surveillance, where health hazards of the identified RCS are measured. The author further explains that health surveillance may typically include a review of whether there are residual adverse effects of RCS exposure to the miners health. It means testing the miners respiratory and skin functioning, as well as inspecting of their urine methanol levels (Chalupka et al 2013). Therefore, as will be shown in the subsequent section, a full RCS health surveillance would include a full exposure and occupational history of the employees, several medical tests (spirometry and blood or urine test), interpretation of results from individual tests, a full report and information on levels of exposure and a compilation of the surveillance report for each employee (Gochfeld et al 2007). During the surveillance, there is a need to ensure that the exposure levels for each employee are well captured and recorded so that they can easily be used for future references. The proper recording also ensures that a new employer is not falsely accused of previous exposures (Chalupka et al 2013). Surveillance before Exposure to RCS For purposes of record keeping, it is important that the workers demographical data are collected especially at their first time of admission into the organization. The following information is contained in the demographic data for each employee: This section contains the employees work history and an identification of whether the employee has had any previous exposure to RCS. Similarly, this section will identify the employees current level of exposure to RCS and whether they have, and use the recommended RCS protective gears. There will be an examination of whether any worker currently displays any symptoms to RCS as well as whether an employee has a history smoking. Similarly, this section of the schedule will use a standardized questionnaire (The Bronchial Symptoms Questionnaire) as part of the medical examination process. Upon conducting the medical investigation, the workers should be exposed to a session of professional medical advice, which enlightens them of the medical risks associated with exposure to RCS and how to minimise such risks. The health surveillance at this stage will be deemed to be effective it provides all the necessary information to prove that the worker was or was not exposed to RCS in his previous place of work. Similarly, an effective surveillance before exposure gives a detailed medical history of the employee for future reference. Health Surveillance during Exposure to RCS As part of the information to be included in the health records of each employee, there will be a collection of details from any formally conducted assessment especially those that are in compliance with NIOSH. Similarly, part of the employee health records will include their job descriptions as well as the start and finish dates. Similarly, all the results of personal and atmospheric monitoring will be included as part of this data. Besides taking the health records for each employee, there will be a periodic (after every 5 years) medical evaluation which includes taking of their medical history, occupational history, physical examination, and investigation (a repeat of steps 1 (a), (b), (c), (d), (e)). The periodic medical evaluations will also be accompanied by their respective epidemiological survey as part of the comprehensive medical evaluation. Equally, there is a need to inform the employer of any abnormal results to enable them to establish proper control measures. Health surveillance during exposure is considered effective when it provides all the information pertaining to the employees health condition enough to facilitate any medical action towards improving the health and well-being of each employee. For instance, it will be considered effective if it ensures that all the workers wear protective gears any time they are within the quarry area. During employee termination, it is important to have comprehensive information about the employee including the reason for termination and date of termination. Equally, if the employee is terminated due to ill health, it is important to record the details of the illness. Likewise, id employee dies during service, the date and cause of death must be recorded. When the employee is terminated, it is important to take them through a final medical examination which includes medical history, physical examination, and investigation. Health surveillance at termination will be considered effective if it establishes the workers exposure levels or status at termination. This means that an effective surveillance at termination should compare the workers level of RCN exposure before joining the organization (before exposure) and at termination. Conclusion Workplace risk assessment should be the basis upon which the development of RCS health surveillance is conducted. Similarly, the health safety of employees in silica-exposed workplaces is only guaranteed when they accept the RCS-based health surveillance as a normal health routine which must be abided by at all costs. In fact, the employees should be involved in the development of health surveillance programs and if need be, there should be adequate training on the importance of fully participating in such programs. There is also a need to orient and inform the workers of how they will be handled during the surveillance program, especially when any abnormal results are detected during testing. This will prepare them psychologically for any outcome and promote their compliance levels to the entire program. Equally, all the information recorded during the health surveillance program should be shared with each individual employee who should then give consent for the information to be passed on to their primary health care provider. Upon collection of such records, they should be kept separately from the organizations human resources to promote confidentiality. For purposes of maintaining standards for RCS-related health surveillance, there is a need to establish and maintain a standardized health surveillance program for all workers within the Australian mining and related industry. On the same note, there is a need to maintain a standardized questionnaire (e.g. the Bronchial Symptoms Questionnaire) and health data recording template as part of maintaining a standardized health surveillance program within Australia. In conclusion, persons responsible for developing health surveillance programs need be knowledgeable of health risks caused by RCS including the radiological complications and its interference with lung function. Hence, it is necessary to keep a continuous identification of training needs to keep up with the advancing complications that RCS may bear. References Arcury, T. A., PhD., O'Hara, Heather, MD, MSPH, Grzywacz, J. G., PhD., Isom, S., M.S., Chen, Haiying,M.D., PhD., Quandt, S. A., PhD. (2012). Work safety climate, musculoskeletal discomfort, working while injured, and depression among migrant farmworkers in north carolina.American Journal of Public Health,102, S272-8. Al Amiry, A. (2015). Review article: Methicillin-resistant Staphylococcus aureus: An occupational health hazard in the prehospital setting. Journal Of Acute Disease, 4274-276. Burgel, Barbara J, RN, COHN-S,PhD., F.A.A.N., Novak, Debra,R.N., D.S.N., Burns, Candace M,PhD., A.R.N.P., Byrd, Annette,M.P.H., R.N., Carpenter, Holly,B.S.N., R.N., Gruden, MaryAnn, MSN, CRNP,N.P.-C., C.O.H.N.-S./C.M., . . . Taormina, Deborah, MS, RN,A.N.P.-B.C., C.O.H.N.-S. (2013). Perceived competence and comfort in respiratory protection: Results of a nationwide survey of occupational health nurses.Workplace Health Safety,61(3), 103-115. Chalupka, Stephanie, EdD, RN,P.H.C.N.S.-B.C., F.A.A.O.H.N. (2013). Medical surveillance for workplace exposure to hazardous drugs.Workplace Health Safety,61(2), 92. Grabinski, C. (2015). Toxicology 101.Chemical Engineering Progress,111(11), 31-36. Gochfeld, Michael,M.D., PhD., Mohr, Sandra,M.D., M.P.H. (2007). Protecting contract workers: Case study of the US department of energy's nuclear and chemical waste management.American Journal of Public Health,97(9), 1607-13. Groenewold, M. R., Baron, S. L. (2013). 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King Lear The Role Of The Fool Essays - King Lear, British Films

King Lear: The Role of the Fool In Shakespeare's, King Lear, the Fool plays three major roles. One of these roles is of an "inner-conscience" of Lear. The Fool provides basic wisdom and reasoning for the King at much needed times. The Fool also works as amusement for Lear in times of sadness and is also one of the only people besides the Duke of Kent and Cordelia who are willing to stand up to the King. The Fool works as the "inner conscience" of Lear throughout the play. The Fool shows Lear the side of reasoning and tries to persuade Lear that it was wrong to banish Cordelia. The Fool only first appears in Act 1, scene four, after Cordelia has moved away with the King of France. The Fool knows that Lear has done wrong by giving all his land away to his to evil daughters, Goneril and Regan, and tells him so in act one, scene four, when he says, "All thy other titles thou hast given away; that thou wast born with." The Fool also warns Lear about Goneril and Regan stating that Lear is now a lap dog to Goneril and Regan, "Truth's a dog must to kennel; he must be whipped out when the Lady Brach may stand by the fire and stink." The Fool disappears in act three, when Lear goes mad. This shows that the Fool is Lear's view of reasoning because when a person goes insane they cannot think straight or reason and therefore after act three there is no need for Lear to have a Fool as he is mad. The Fool also tries to help Lear to feel a bit better about what is going on by putting a humorous spin on the words he is saying. The Fool uses poetry and song to get his view across to Lear. In act one, this is visible in numerous ways. For example, in scene four the Fool sings: Then they for sudden joy did weep, And I for sorrow sung, That such a King should play bo-peep And go the fools among. This little verse helps the Fool the show Lear again that dividing his kingdom was a mistake. The Fool throughout this act also refers to Lear as a fool himself and many times offers him his coxcomb. In King Lear, there are only three people with the ability to stand up to Lear. Cordelia, Kent and the Fool. During the play Lear threatens to have the Fool whipped for what he says, when Cordelia and Kent get banished from the Kingdom for speaking their minds. This just shows the special relationship the Fool and Lear have during the play. This point is emphasised later in the play when Lear shows concern and compassion towards the Fool, "Come on, my boy. How dost my boy, art thou cold?" The Fool is not just a servant to Lear but is also a friend and the son Lear never had. The name "Fool" means nothing. He is the most intelligent and insightful character in the play and provides simple and clear reasoning for a one sighted King. The Fool is loyal to the bitter end and provides the little bits of humour in this play. He has honesty and integrity that is only found in a few other characters in the play. Bibliography KING LEAR BOOK