The Weakness of Contemporary Cultural Medicine

The term Cultural Medicine is used to refer to changes to a medical system provided specifically to reach out to and serve a diverse culture. The title is applied differently than Integrative Medicine. Integrative Medicine acknowledges that there are different preventive and reactive ways to address issues of preventive health, health maintenance, disease, injury and medical care (IntgMed), many of them cross-cultural. Cultural Medicine is applied to all that is not specifically IntgMed. Rather, it is that which supports underlying layers of infrastructure required to deliver ever-expanding, culture-specific positions, products and services, rather than focused, inclusive services.An example of inclusive delivery is recognition that the national language is English. A focused, nationally oriented, fully integrative system of medicine would acknowledge the beneficial elements of all IntgMed, but it would be delivered in English (except non-translatable elements). This approach encourages all citizens to learn and excel in English and markedly limits the cost of IntgMed products/services components delivery. If for example, government-paid and/or delivered services focus on delivering a more culture-neutral, English-based IntgMed service only, costs would be markedly reduced and all citizen-consumers would be encouraged to become more English-language proficient. As an aside, pharmaceutical products, medical technologies, acupuncture needles, physical therapeutic manipulations and exercises, and other key elements of IntgMed do not recognize the human body as gender, ethnicity or culture-specific – they simply perform functions. Such subdivisions are behaviors of service providers.

One of the primary sets of questions ignored by state and U.S. governmental agencies is:1. Who is most qualified to determine if a proposal or intervention should be that in which we should invest given all other needs, ideas, and proposals?2. Who should be responsible for payment for this proposal/intervention if we proceed with it?3. Define success. What does it look like?4. When (initial and follow-up) and how shall we measure the effectiveness of the subsequent program, service, or intervention?5. Is it not appropriate for payers (e.g., public taxpayers) to receive easily accessible, unbiased reporting of interim services delivery progress and performance measurements?”, and6. What will we do if measured results are not as expected and desired (e.g., inadequate Return on Investment)?If you took your car in for service, paid for the services, and only fifty percent of the claimed fixes were effective, would you be satisfied? No, you would not be satisfied. If the same automotive repair company employed you, yet still provided you and your peers with the above-described poor service, would you then be satisfied and recommend to your friends that they should be satisfied in similar circumstances? You should respond, “No.” You should not be favorably biased toward the repair company simply because it employs you. However, government initiatives usually provide many millions, if not billions of dollars to the recipients of their investments, including the creation of well-paying jobs. And, unlike as would be the case in private industry, recipients of these public windfall monies and opportunities are loath to give up your tax money, and are often willing to publicly denigrate you for demanding that they be held accountable (e.g., fix the entire car as promised versus aren’t you satisfied with partial function?)There are numerous governmental pseudo-medical/medical programs that are abysmal failures, that continue to expand. In spite of their prolonged failures at missions to curtail drug abuse, misuse, pharmaceutical products-related deaths, decrease STD/STI incidence, minimize gender-critical maladies, and social disruptions due to related issues, the programs and funding persist. With grand budgets and swollen senses of importance and entitlement, no one receives good answers to above listed six questions from these program representatives. Such are the effects and weaknesses of contemporary Cultural Medicine. Everyone in the culture, position-empowered or not, rich and poor, citizens or not, payers or not, aware of and sensitive to current budget constraints or not, believes that they should receive timely, broad-based, sometimes very expensive, individualized care and financing of their programs. And, numerous cultural subgroups (geographic, ethnic, gender-specific, age-specific, financial, religious, secular, other) with sufficient financing and/or sophisticated representation, lobby for special consideration. To suggest that they do not have the right to do so would be politically incorrect and insensitive, right?

Contact your local, regional, state and national government representatives to determine how they are addressing the weakness of contemporary Cultural Medicine in your neighborhood.

Alternative Financing Vs. Venture Capital: Which Option Is Best for Boosting Working Capital?

There are several potential financing options available to cash-strapped businesses that need a healthy dose of working capital. A bank loan or line of credit is often the first option that owners think of – and for businesses that qualify, this may be the best option.

In today’s uncertain business, economic and regulatory environment, qualifying for a bank loan can be difficult – especially for start-up companies and those that have experienced any type of financial difficulty. Sometimes, owners of businesses that don’t qualify for a bank loan decide that seeking venture capital or bringing on equity investors are other viable options.

But are they really? While there are some potential benefits to bringing venture capital and so-called “angel” investors into your business, there are drawbacks as well. Unfortunately, owners sometimes don’t think about these drawbacks until the ink has dried on a contract with a venture capitalist or angel investor – and it’s too late to back out of the deal.

Different Types of Financing

One problem with bringing in equity investors to help provide a working capital boost is that working capital and equity are really two different types of financing.

Working capital – or the money that is used to pay business expenses incurred during the time lag until cash from sales (or accounts receivable) is collected – is short-term in nature, so it should be financed via a short-term financing tool. Equity, however, should generally be used to finance rapid growth, business expansion, acquisitions or the purchase of long-term assets, which are defined as assets that are repaid over more than one 12-month business cycle.

But the biggest drawback to bringing equity investors into your business is a potential loss of control. When you sell equity (or shares) in your business to venture capitalists or angels, you are giving up a percentage of ownership in your business, and you may be doing so at an inopportune time. With this dilution of ownership most often comes a loss of control over some or all of the most important business decisions that must be made.

Sometimes, owners are enticed to sell equity by the fact that there is little (if any) out-of-pocket expense. Unlike debt financing, you don’t usually pay interest with equity financing. The equity investor gains its return via the ownership stake gained in your business. But the long-term “cost” of selling equity is always much higher than the short-term cost of debt, in terms of both actual cash cost as well as soft costs like the loss of control and stewardship of your company and the potential future value of the ownership shares that are sold.

Alternative Financing Solutions

But what if your business needs working capital and you don’t qualify for a bank loan or line of credit? Alternative financing solutions are often appropriate for injecting working capital into businesses in this situation. Three of the most common types of alternative financing used by such businesses are:

1. Full-Service Factoring - Businesses sell outstanding accounts receivable on an ongoing basis to a commercial finance (or factoring) company at a discount. The factoring company then manages the receivable until it is paid. Factoring is a well-established and accepted method of temporary alternative finance that is especially well-suited for rapidly growing companies and those with customer concentrations.

2. Accounts Receivable (A/R) Financing - A/R financing is an ideal solution for companies that are not yet bankable but have a stable financial condition and a more diverse customer base. Here, the business provides details on all accounts receivable and pledges those assets as collateral. The proceeds of those receivables are sent to a lockbox while the finance company calculates a borrowing base to determine the amount the company can borrow. When the borrower needs money, it makes an advance request and the finance company advances money using a percentage of the accounts receivable.

3. Asset-Based Lending (ABL) - This is a credit facility secured by all of a company’s assets, which may include A/R, equipment and inventory. Unlike with factoring, the business continues to manage and collect its own receivables and submits collateral reports on an ongoing basis to the finance company, which will review and periodically audit the reports.

In addition to providing working capital and enabling owners to maintain business control, alternative financing may provide other benefits as well:

  • It’s easy to determine the exact cost of financing and obtain an increase.
  • Professional collateral management can be included depending on the facility type and the lender.
  • Real-time, online interactive reporting is often available.
  • It may provide the business with access to more capital.
  • It’s flexible – financing ebbs and flows with the business’ needs.

It’s important to note that there are some circumstances in which equity is a viable and attractive financing solution. This is especially true in cases of business expansion and acquisition and new product launches – these are capital needs that are not generally well suited to debt financing. However, equity is not usually the appropriate financing solution to solve a working capital problem or help plug a cash-flow gap.

A Precious Commodity

Remember that business equity is a precious commodity that should only be considered under the right circumstances and at the right time. When equity financing is sought, ideally this should be done at a time when the company has good growth prospects and a significant cash need for this growth. Ideally, majority ownership (and thus, absolute control) should remain with the company founder(s).

Alternative financing solutions like factoring, A/R financing and ABL can provide the working capital boost many cash-strapped businesses that don’t qualify for bank financing need – without diluting ownership and possibly giving up business control at an inopportune time for the owner. If and when these companies become bankable later, it’s often an easy transition to a traditional bank line of credit. Your banker may be able to refer you to a commercial finance company that can offer the right type of alternative financing solution for your particular situation.

Taking the time to understand all the different financing options available to your business, and the pros and cons of each, is the best way to make sure you choose the best option for your business. The use of alternative financing can help your company grow without diluting your ownership. After all, it’s your business – shouldn’t you keep as much of it as possible?