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Variance shows the change from a particular period to another which can be in months, quarters, or years. According to Garrison, Noreen, and Brewer (2003), variance analysis is necessary when evaluating the financial statements and departmental level budgets for the overall financial health of an organization or department. The calculation of variance helps to establish whether an organization is growing or not and at what rate. Variance analysis provides the management team with concrete information on how to make business decisions that would strengthen the financial position of an organization (Garrison, Noreen & Brewer, 2003). The Northeast Health System appears stable in various financial aspects but with normal changes between 2010 and 2011. The health system income statement shows that there was a decrease in the total unrestricted revenue and support in 2011 as compared to 2010 though the total expenses reduced from 2010 to 2011. However, the changes in unrestricted net assets show that year 2011 ended with negative (-) changes as compared to 2010 probably due to huge pension and post-retirement remittances in 2011.

From the variances data obtained, the major positive variances between 2010 and 2011 are observed in cash and cash equivalents (41.3), excess of revenue and gains over expenses (223), net assets from restrictions of purchase of property (68.3), and pension and post-retirement related adjustments (390.3). The significant negative variances are observed in prepaid expenses and other current assets (-87.9), non-operating gains (-197.4), change in net unrealized gains and losses on investments (-170.9), total other changes in unrestricted net assets (-578.1), and a decrease in unrestricted net assets (-283.6). The variances show that there were significant differences in particular aspects of the financials of Northeast Health System both positive and negative.

According to the proportional allocation analysis data, the most significant positive proportions are net patient service revenue for both 2010 and 2011[98.0 (2011); 97.7 (2010], income from operations in 2011 (211.9), change in net unrealized gains and losses on investments in 2011 (167.1), and decrease in unrestricted net assets in 2011 (158.1). The most significant negative proportions from the analysis data are non-operating gains in 2011 (-111.8), and pension and post-retirement related adjustments in 2011 (-76.4).

Most of the financial aspects of Northeast Health System are not heading in the right direction since most of the variances are negative. It shows that the financial health of the firm in 2010 was better than that of 2011. However, the variances in pension and post-retirement related adjustments and excess of revenue and gains over expenses shows that there were more expenses on the two items in 2011 than 2010. Regarding the firm liabilities, the changes were not significant that showed a level of stability. The firm’s assets appear to be on a downfall trend which reveals of some losses or depreciation. For the proportion allocation analysis, it is evident that unrestricted revenues and support decreased in 2011 as compared to 2010, total expenses also reduced in 2011 thereby making the gains over expenses to increase in 2011 as compared to 2010. The major problem experienced in 2011 was the increase in pension and postretirement adjustments as well as fluctuations in unrealized gains and losses on investments.

I would recommend certain actions to the Northeast Health System regarding decreasing or increasing the significant variances and proportional allocations. First is to reduce the accrued wages and vacation payable, the accrued pension liability, and professional liability reserves. The Health facility ought to diversify on the mechanisms of revenue generation to ensure there is an increase in cash flow. The allocations for pension and post-retirement adjustments ought to be controlled to avoid the rapid changes in unrestricted net assets.

1. Discuss the psychological factors associated with pain and, at least, one psychosocial intervention used to treat pain.

Psychological factors related to pain disorder get viewed to play a significant role in the onset, seriousness, exacerbation or maintenance of the pain. Psychological assessment assists in understanding patient’s experience of pain together with any associated pain behavior such as grimacing, postural changes and expressions of face. It also assists in identifying coping strategies that get used by the patient and whether they result in a positive outcome such as distraction and staying busy or adverse outcome such as catastrophising and limitation of activity. The diagnosis of pain disorder with psychological factors gets made when the patient’s reaction is out of proportion to the physical condition and when deficits in psychosocial functioning occur.

The psychological factors associated with pain include (Turk & Gatchel, 2013).

Cognitions: Fear about paralysis and despondency can result in elevated levels of pain.
Emotion: High levels of pain get associated with fear, anxiety, general stress and depression. High levels of these aspects compel individuals to seek medical treatment for the pain.
Behavior: Pain gets associated with low self-esteem as well as marked avoidance
Attention: Giving a particular pain lot of attention can result in elevated intensity.
Interpretation: Pain gets assessed differently by different patients, for instance, an individual who suffered a heart attack may ignore a muscle twitch in the chest.
Expectations: The type of expectation an individual has towards a particular pain may affect the feedback received from pain receptors.
Context: The time when pain is occurring determines the pain felt by a person, for instance, a patient who has got injected with anesthesia in a theater surgery procedure may not feel the pain until later.
Coping approaches: Different approaches get used to minimize pain. They include biofeedback, visualization, positive affirmations, and distraction.
Cognitive-Behavioral Therapy for Pain Management
This psychosocial treatment process involves several phases. The first step in treatment is pain education, where a patient gets explained about pain, how the role of own response towards pain influences pain experience and coping strategies in pain control. The second step involves in one or more coping skills for pain management. The therapist provides an educational rationale, basic instruction as well as guided practice and feedback got each strategy taught. The third step involves home practice with the skills learned from the therapist. The last step of treatment involves assisting patients to establish a program for maintaining their skills practice after the completion of training and for overcoming setbacks and relapses in the coping strategies.

2. Pick two of the five theoretical models of coping with chronic illness and describe in detail. What adherence interventions would be effective in the two models you choose?

Self-Regulation Model
It is a theoretical model of goal-directed behavior that gets applied to understanding people’s ability to cope with the chronic disorder. In this model, the human behavior gets influenced by objectives through which individuals seek to develop particular desired conditions in their lives. Patients use the self-realization process to strive to achieve certain goals. This model gets based on the assumption that patients experience stress when they get hindrances towards achieving their goals and dealing with stress gets conceptualized as efforts at self-regulation based on that adversity. Suffering from a chronic illness is stressful to the extent that it gets viewed to prevent a patient’s goals and their ability to deal successfully with the disease get determined by their capacity to reassess the goals (Suls, Davidson & Kaplan, 2010).

Self-Determination Model
It is a theoretical model based on a broader theory of human motivation and behavior referred to as self-determination theory. The theory assumes that humans have three natural psychological needs namely, autonomy, competence, and relatedness to others and when these needs get met; persons usually experience improved self-motivation, development, and well-being. The theory recognizes that behavioral and affective factors of coping with chronic diseases such as diabetes and hypertension get facilitated by self-management. According to this model, people’s motivations for autonomy and competence are vital in successfully coping with chronic illnesses. Autonomy motivation occurs when individuals experience volition and choice in their illness-related behaviors, whereas competence occurs when patient’s feel that they can control important disease-related outcomes.