General trends. Storing thermal energy can compensate a temporary imbalance between supply and demand or greatly reduce it. Thermal storage for the short term (< 1 week) is implemented most. Examples are warm-water boilers in homes, and ice storage for air-conditioning plants in offices. Short-term storage systems lower the maximum demand capacity on the supply side. As a consequence, power companies can, for example, lower the maximum capacity setting and operate their power stations more efficiently. They stimulate the application of storage via rates (tariffs). Consumers will generally not save energy by short-term storage. The main objective of short-term storage is to compensate the imbalance between demand and available thermal capacity. The application of seasonal thermal energy storage (>3 months) is currently much less common. This is not due to a smaller technical potential. On the contrary, there is a large amount of surplus heat in summer and surplus cold in winter. Further application is mainly delayed by economic factors, and to a lesser extent by technical ones. In the past 15 years various applications of UTES (Underground Thermal Energy Storage) have been studied. Much attention has been given to the development of storage techniques. It appears that the development of a given type of storage technique greatly depends on local geological conditions. Therefore, for example, in areas without natural storage structures, small-scale storage systems in particular have been studied. The analysis of supply and demand systems has received little attention. Many well-functioning systems have been developed in the past few years which, however, have not been implemented to a great extent. Furthermore, it is remarkable that attention in the initial years was primarily aimed at heat storage. The drop in prices of prime energy, and hydrothermal problems in storage have caused the number of applications of heat storage to be relatively small. Attention to the application of cold storage has greatly increased in the past few years, partly due to the increasing demand for cooling in buildings and the increased attention to environmental impacts caused by using chillers.
General trends. The main positive environmental impact of UTES is energy saving. This is in the interest of sustainable application of energy sources and the reduction of CO2 (greenhouse effect) and acid equivalents (acid rain). These environmental impacts are however mainly related to the environment compartment "air". To arrive at a balanced environment judgment of UTES, it is important to take other compartments, like water, ground, noise and space, into account. Besides one should also have to look at the environmental impact of the materials used for constructing and maintaining UTES. An life-cycle analysis of the used materials is however beyond the scope of this report.
General trends. The chapter has reviewed recent developments since the adoption of the TRIPS Agreement that by itself represented a major shift in the evolution of the international IP architecture. TRIPS recognized that Members shall not be obliged to implement in their law more extensive protection than is required by the Agreement, and that such protection shall not contravene the provisions of TRIPS. This is, in essence, the embodiment of the principle of minimum standards. PTAs, characterized in general as instruments that go beyond the TRIPS Agreement, are a legitimate consequence of TRIPS. They have meant in practice a major expansion of those minimum standards with important consequences in a number of areas such as those reviewed here, mainly access to medicines, genetic resources, copyright issues regarding the shrinking of the public domain and settlement of disputes and enforcement issues. Overall, this chapter has shown that with respect to the policy areas reviewed, the PTAs have shifted the balance in favor of private rights holders. The impact generated through PTAs in reducing access to essential products, such as medicines or educational material, narrowing down the public domain of essential information needed for the development of technological capacities, creative works, and further reducing a pro-competitive environment should be a source of concern and a major challenge to policy makers, especially, but not only, in developing countries. To 257 See, for example, Article 17.11.29 (US-Australia FTA), Article 16.9.22 (US-Singapore FTA) and Article 15.11.27, CAFTA. 258 See Musungu 2008 restore the necessary balance between producers and consumers of IPRs, policy makers need to become aware of and make use of the flexibilities that have remained in place, for example through the application of strict patentability criteria or the innovative and constructive implementation of PTAs into national laws. Proposals in the literature illustrate the potential to accommodate public interest concerns even within the most delicate legislative framework. Policy makers universally, not just in developing countries, should seek to identify common interest denominators, based on the understanding that for the promotion of innovation, there is an optimal level of IP protection, beyond which ever-increasing exclusive rights will prove counterproductive to society at large.259 In brief, despite its importance for technological innovation and cultural progress, the public...
General trends. An increased proportion of the Company's revenue is derived from fixed payment services, including Medicare and Medicaid which accounted for 50%, 48% and 45% of the Company's net patient revenues during 1996, 1995 and 1994, respectively. The Company expects the Medicare and Medicaid revenues to continue to increase as a larger portion of the general population qualifies for coverage as a result of the aging of the population and expansion of state Medicaid programs. The Medicare program reimburses the Company's hospitals primarily based on established rates by a diagnosis related group for acute care hospitals and by cost based formula for behavioral health facilities. In addition to the Medicare and Medicaid programs, other payors continue to actively negotiate the amounts they will pay for services performed. In general, the Company expects the percentage of its business from managed care programs, including HMOs and PPOs to grow. The consequent growth in managed care networks and the resulting impact of these networks on the operating results of the Company's facilities vary among the markets in which the Company operates. HEALTHCARE REGULATION AND LEGISLATION In addition to the trends described above that continue to have an impact on operating results, there are a number of other more general factors affecting the Company's business. In February 1997, the President submitted his fiscal year 1998 budget plan which calls for a $100 billion reduction in the rate of increase in Medicare spending over the next five years and a $138 billion reduction over six years. Included in this proposal are reductions in the future rate of increases to payments made to hospitals. Both Republicans and Democrats are working towards a balanced budget by the year 2002 and it is likely that future budgets will contain certain reductions in the rate of increase of Medicare and Medicaid spending. The Company cannot predict whether the above proposal or any other proposals will be adopted, and if adopted, no assurance can be given that the implementation of such plans will not have a material adverse effect on the Company's business. In Texas, a law has been passed which mandates that the state senate apply for a waiver from current Medicaid regulations to allow the state to require that certain Medicaid participants be serviced through managed care providers. The Company is unable to predict whether Texas will be granted such a waiver or the effect on the Company's business o...
