4'%14&8QNWOG0Q
%QNQTCFQ5RTKPIU5RTKPI/GGVKPI
,WPGä
5GUUKQP2&
7VKNK\CVKQP4GXKGY+UUWGU
6TCEM
-G[YQTFU
*GCNVJ
2TKEKPI4GUGCTEJ
/QFGTCVQT
2CPGNKUVU
41$'46*&1$510
$4'06.'')4''0911&
<1'//%%#46*;
9'5.';5%#48'4
4GEQTFGT
5WOOCT[*QYECPCOCPCIGFECTGRNCPMPQYYJGVJGTKVKUFQKPICIQQFLQDQP
WVKNK\CVKQPTGXKGY!+UVJGTGTQQOHQTHWTVJGTTGFWEVKQPKPWVKNK\CVKQP!*QYUJQWNFC
OCPCIGFECTGRNCPRTGXGPVWPFGTWVKNK\CVKQP!*QYFQGUPGYNGIKUNCVKQPCHHGEVVJKU
HWPEVKQP!
/T4QDGTV*&QDUQP1WTHKTUVURGCMGTKU<QG/E%CTVJ[<QGKUCP#5#CPFJCU
URGPV[GCTUCV6TKIQP$NWG%TQUU$NWG5JKGNFKP4KEJOQPF8KTIKPKC6JGNCUV
QPGCPFCJCNHQHVJQUG[GCTUJCXGDGGPKPVJGJGCNVJCPFYGNNPGUUCTGC5JGçU
IQKPIVQDGQWTHKTUVURGCMGTCPFVJGVQRKEYKNNDG/GCUWTGOGPV5[UVGOUKP
RCTVKEWNCTQPGVJCV6TKIQPJCUKPUVCNNGFTGEGPVN[+çOCEQPUWNVKPICEVWCT[YKVJ/KNNK
OCP4QDGTVUQP
/4+çOKPVJG6CORCQHHKEGYJKEJKUPQYQPG[GCTQNF+çXG
DGGPYKVJ/4CNKVVNGQXGT[GCTU+çOIQKPIVQDGEQXGTKPICNNVJGRQKPVUVJCV
PQDQF[GNUGYCPVGFVQEQXGT6JCVçUYJCVVJGOQFGTCVQTIGVUVQFQ
$TGPV)TGGPYQQFYKNNFQQWTYTCRWR*GçUIQKPIVQDGNQQMKPIKPVQVJGHWVWTGCPF
VGNNKPIWUYJGTGJGVJKPMUWVKNK\CVKQPTGXKGYKUIQKPIVQDGIQKPI$TGPVKURTCEVKEG
OCPCIGTYKVJVJG6QYGTU2GTTKP+*%RTCEVKEGKP#VNCPVC*GJCUDGGPYKVJ6QYGTU
2GTTKP[GCTUCNNKPVJGOCPCIGFECTGWPKV*GJCUGZRGTKGPEGKPCEVWCTKCN
OCPCIGOGPVKUUWGUQH*/1U221UQVJGTOCPCIGFECTGQTICPK\CVKQPUCUYGNNCU
KP/GFKECTGCPF/GFKECKF*GCNUQYCUQPGQHVJGGKIJVCEVWCTKGUEJQUGPVQCWFKV
2TGUKFGPV%NKPVQPçUJGCNVJECTGTGHQTORTQRQUCN
%QR[TKIJV l 5QEKGV[ QH #EVWCTKGU
4'%14&8QNWOG
+LWUVYCPVGFVQOCMGCEQWRNGQHKPVTQFWEVQT[TGOCTMUDGHQTG+VWTPKVQXGTVQ<QG
+PCTGEGPV0GYUYGGM[QWOC[JCXGUGGPVJGCTVKENGQP*/1UUJQYKPIC
FQEVQTYKVJUEKUUQTUKORN[KPIEQUVEWVVKPI+CNYC[UVJKPMKVOGCPUCITGCVFGCNVQ
QWTDWUKPGUUYJGPVJGKUUWGUVJCVYGçTGYQTTKGFCDQWVOCMGKVKPVQVJGRQRWNCT
RTGUU1PGQHVJGVJKPIU+CUMGFVJGRCPGNKUVUVQFQHQTVJKUUGUUKQPYCUVQVT[VQ
EQOGWRYKVJUQOGEQPVTQXGTUKCNVJKPIUDGECWUGYGJCXGCTGNCVKXGN[UOCNNCWFK
GPEG9GçNNJCXGUQOGVKOGHQTSWGUVKQPUCPFCPUYGTUCVVJGGPFCPF+çOJQRKPI
QPVJGWPNKMGN[EJCPEGVJCVYGFQPçVUC[CP[VJKPI[QWFKUCITGGYKVJVJCV[QWçNN
EQOGWRYKVJUQOGVJKPIUVJCVYGFKUCITGGYKVJUQYGECPJCXGUQOGEQPVTQXGTU[
CPFUQOGFKUEWUUKQP
1PGQHVJGVJKPIUHQTGZCORNGVJCVCNYC[UIGVUCIQQFHKIJVIQKPICVO[JQWUGKUVQ
VCNMCDQWVOCVGTPKV[UVC[U6JGKUUWGTGCNN[EQOGUFQYPVQQPGXGTUWUVYQFC[UQP
CPQTOCNFGNKXGT[/[YKHGYJQJCRRGPUVQDGCP40YKNNVCNMCDQWVJQYC
OQVJGTYJQJCUQVJGTMKFUCVJQOGPGGFUVQUVC[KPVJGJQURKVCNCPFTGUVNQPIGT1T
KHKVçUJGTHKTUVEJKNFVJCVUJGPGGFUVQDGVTCKPGFOQTGGURGEKCNN[KHUJGFQGUPçVJCXG
GPQWIJGFWECVKQP+QHEQWTUGVCMGVJGRQUKVKQPVJCVçUCNNHKPGDWVKVFQGUPçVPGGF
VQDGFQPGKPCPGZRGPUKXGJQURKVCNKVEQWNFDGFQPGVJTQWIJJQOGJGCNVJQT
UWDCEWVGECTG/[YKHGFKFJCXGCUJQTVGZRGTKGPEGCUCWVKNK\CVKQPTGXKGYPWTUGHQT
CP*/15JGYQTMGFVJGTGCDQWVCOQPVJDGHQTGUJGçFJCFCNNUJGEQWNFVCMG
5JGYCUYQTMKPIYKVJC/GFKECKFRNCPCPFQHEQWTUGOQUVQHVJGECNNUYGTG
EQOKPIKPHTQOGOGTIGPE[TQQOU#EQWRNGQHO[HCXQTKVGUVJCVUJGVQNFOGCDQWV
YGTGCRCVKGPVYJQRTGUGPVGFYKVJCEQNFCPFCFGITGGHGXGTCPFCPQVJGTQPG
YJQRTGUGPVGFCVVJGGOGTIGPE[TQQOHQTJKUEJGEMWR
6JGVJKPIVJCVTGCNN[DQVJGTUOGKUVJCVCNN[QWTGCFCDQWVVJKUVQRKEKPVJGRQRWNCT
RTGUUUGGOUVQKORN[VJCVYGCUKPUWTCPEGEQORCPKGUQTOCPCIGFECTGQTICPK\C
VKQPUCTGUC[KPIVJCVRGQRNGECPçVIGVVJGUGTXKEG+FQPçVVJKPMCP[DQF[çUUC[KPI
VJCV9GçTGLWUVUC[KPIYGçTGPQVIQKPIVQRC[HQTKVQTKVYQPçVDGEQXGTGFDGECWUG
YGFQPçVEQPUKFGTKVOGFKECNN[PGEGUUCT[0QDQF[UGGOUVQRKEMWRQPVJCV
FKUVKPEVKQP5QVJCVçUQPGQHVJGVJKPIU+çFNKMGVQUGGWUVCNMCDQWVKPVJGSWGUVKQP
CPFCPUYGTRGTKQFKHPQYJGTGGNUG+FKFPçVKPVTQFWEGQWTTGEQTFGTYJQKU9GU
%CTXGT*GçUCP(5#CV6TKIQP<QGYCUMKPFGPQWIJVQTGETWKVJKO
/U<QG//E%CTVJ[+YKNNRTGUGPVCWVKNK\CVKQPVQQNVJCVYGCHHGEVKQPCVGN[ECNN
ENCKOUCPCN[UKUTGRQTVKPIU[UVGO
%#45/[QDLGEVKXGUCTGHKTUVVQFGOQPUVTCVG
YJCVVJG%#45VQQNKUCPFUGEQPFVQFKUEWUUJQY%#45ECPDGWUGFVQGXCNWCVG
WVKNK\CVKQPTGXKGYGHHQTVU
#UYGKORNGOGPVOQTGCPFOQTGOGFKECNOCPCIGOGPVRTQITCOUYGPGGF
YCTPKPIUVQJGNRWUKFGPVKH[VJGRTQDNGOCTGCUYJGTGWVKNK\CVKQPFQGUPQVEQORCTG
YGNNYKVJKPVGTPCNQTPCVKQPCNPQTOU9GPGGFKPFKECVQTUVJCVYKNNJGNRWUVQ
7VKNK\CVKQP4GXKGY+UUWGU
OQPKVQTVJGUWEEGUUQHYJGPYGJCXGKORNGOGPVGFOCLQTRTQITCOU0QYYG
FQPçVWUG%#45VQOGCUWTGVJGUWEEGUUQHCRCTVKEWNCTRTQITCODWVYGECPIGVC
IQQFKPFKECVKQPQHYJGVJGTVJGRTQITCOUCTGYQTMKPIQTPQVQXGTCNN(KPCNN[YG
PGGFVQDGCDNGVQVTCPUNCVGQWTGZRGEVCVKQPUHQTWVKNK\CVKQPTGFWEVKQPUKPVQFQNNCT
TGFWEVKQPUHQTHKPCPEKCNDWFIGVU%#45ECPJGNRWUOGGVVJGUGPGGFU
5QYJCVKU%#45!+VRTQFWEGUCUGVQHEQUVCPFWVKNK\CVKQPOGCUWTGU6JGFCVCDCUG
CPFOQFGNYGTGEQPEGKXGFFGUKIPGFCPFFGXGNQRGFKPVJG6TKIQP$NWG%TQUU$NWG
5JKGNFQH8KTIKPKC#EVWCTKCN&GRCTVOGPVKP(QTVJGHKTUV[GCT%#45YCUWUGF
OQUVN[KPQWTFGRCTVOGPV6JGTGUVQHVJGEQORCP[YCUPçVVQQKPVGTGUVGF(QWT
[GCTUNCVGTYGECPçVRTQFWEGVJGUGTGRQTVUHCUVGPQWIJHQTQWTKPVGTPCNCPFUQOG
GZVGTPCNEWUVQOGTU
.QQMKPICVWVKNK\CVKQPTGXKGYKUQPGQHVJGOCP[WUGUQH%#456JGHQTOCVCPFYJCV
YGFGEKFGFVQKPENWFGKPVJKUTGRQTVJCXGDGGPTGXCORGFUGXGTCNVKOGUCUYGNGCTP
OQTGCPFOQTGCDQWVQWTFCVC9GçTGXGT[RTQWFQHCNNVJGKPHQTOCVKQPYGJCXG
USWGG\GFQPVQQPGRCIGKPCHWPEVKQPCNHQTOCV/C[DGVJKUYKNNDGO[EQPVTQXGTU[
CUKVçURQUUKDN[PQVCTGCFCDNGHQTOCVDWVKVçUCHWPEVKQPCNHQTOCV6JGTGCTGCNQVQH
VKP[PWODGTUQPVJGTGDWVKVTGCNN[KUJGNRHWNVQJCXGKVQPQPGRCIG6JGTGCTGHKXG
OCLQTUGEVKQPUQPCUVCPFCTF%#45TGRQTV9GJCXGRNCEGUQHVTGCVOGPVUGTXKEGU
EQUVCPFWVKNK\CVKQPOGCUWTGUGPTQNNOGPVCPFTGRQTVKPIQRVKQPU
6JGRNCEGUQHVTGCVOGPVCTGCVCPKPRCVKGPVHCEKNKV[CPFRCTVKCNFC[HCEKNKV[7PFGT
RCTVKCNFC[YGEQXGTRCTVKCNFC[UKPVJGJQURKVCNHQTOGPVCNJGCNVJCPFHQTUWDUVCPEG
CDWUG9GCNUQJCXGQWVRCVKGPVHCEKNKV[RTQHGUUKQPCNRTQXKFGTKPRCVKGPVCPF
RTQHGUUKQPCNRTQXKFGTQWVRCVKGPV0QYKH[QWçFDGGPNQQMKPICVVJGUG%#45TGRQTVU
QXGTVKOG[QWYQWNFJCXGQDUGTXGFCPKPETGCUGKPVJGQWVRCVKGPVRGTEGPVCIGCPFC
FGETGCUGKPVJGKPRCVKGPVRGTEGPVCIGCUYGUJKHVGFKPRCVKGPVUGTXKEGUVQVJG
QWVRCVKGPVUGVVKPI6JGECVGIQTKGUQHKPRCVKGPVUGTXKEGUCTGDCUGFQPRCVKGPVUç
RTKOCT[FKCIPQUGUHQTUGTXKEGU
6JGTGCTGVJTGGUGEVKQPUVJCVUJQYVJGUGTXKEGUWPFGTQWVRCVKGPVHCEKNKV[CPFKPRC
VKGPVCPFQWVRCVKGPVRTQHGUUKQPCNRTQXKFGTRNCEGUQHVTGCVOGPV6JGUGUGTXKEGUCTG
DCUGFQPVJGRTQEGFWTGURGTHQTOGF'ZEGRVHQTCEQWRNGQHUGTXKEGUVJGUGTXKEGU
CTGVJGUCOGHQTCNNVJTGGRNCEGUQHVTGCVOGPVKPVJQUGPGZVVJTGGUGEVKQPU
6JGGXCNWCVKQPUCPFOCPCIGOGPVUGTXKEGUCTGXGT[FKHHGTGPVCETQUURNCEGUQH
VTGCVOGPV(QTGZCORNGJQURKEGKUHQWPFQPN[KPVJGQWVRCVKGPVHCEKNKV[0GYDQTP
ECTGKUHQWPFQPN[KPKPRCVKGPVRTQHGUUKQPCNRTQXKFGT#PFRTGXGPVKXGOGFKEKPGKU
HQWPFQPN[KPQWVRCVKGPVRTQHGUUKQPCNRTQXKFGT+VJKPM$QDKUIQKPIVQVCNMCNKVVNGDKV
CDQWVJQOGJGCNVJYJKEJ[QWECPHKPFKPVJGQWVRCVKGPVRTQHGUUKQPCNRTQXKFGT
4'%14&8QNWOG
6JGEQUVCPFWVKNK\CVKQPOGCUWTGUVJCVCTGVJGDWNMQHVJKUTGRQTV6JGPQTOCN
KPRCVKGPVWVKNK\CVKQPOGCUWTGUCTGTGRQTVGFD[FC[UCFOKUUKQPUCPFCXGTCIGNGPIVJ
QHUVC[&C[UCPFCFOKUUKQPUCTGTGRQTVGFQPCRGTVJQWUCPFOGODGTUDCUKUVQQ
(QTCFOKUUKQPEQWPVKHCRCVKGPVIQGUQWVQPCHWTNQWIJHQTVJTGGFC[UQTNGUUYG
EQODKPGVJGFC[UDGHQTGVJGHWTNQWIJCPFVJGFC[UCHVGTCPFRWVKVKPVQQPG
CFOKUUKQP9GFQPçVEQWPVVYQCFOKUUKQPU#NUQHQTKPVGTKODKNNKPIKPJQURKVCNU
YGFQPçVYCPVVQEQWPVCFOKUUKQPUDGECWUGCJQURKVCNKPVGTKODKNNUGCEJOQPVJ
5QYGIQDCEMCPFRWNNVJQUGVQIGVJGTCPFEQWPVVJGOCUQPGCFOKUUKQPCPFGCEJ
OQPVJVJKUEQODKPKPIQTTQNNKPIQHCFOKUUKQPUKUTGHTGUJGFNQQMKPICVOQPVJUQH
RCKFFCVC
9GJCXGVJTGGMKPFUQHWVKNK\CVKQPHQTVJGPQPKPRCVKGPVHCEKNKV[RNCEGUQHVTGCVOGPV
'PEQWPVGTUCPFKPEKFGPVUOC[DGDGUVFGUETKDGFD[CPGZCORNG5CNN[YGPVVQC
RTQXKFGTCPFJCFVYQUWTIKECNRTQEGFWTGURGTHQTOGFCPFVJTGGFKCIPQUVKEVGUVUCNN
QPVJGUCOGFC[CPFCVVJGUCOGRTQXKFGT9GYQWNFEQWPVCNNHKXGQHVJQUG
RTQEGFWTGUCUQPGGPEQWPVGTDGECWUGUJGJCFVJGOCNNCVVJGUCOGRTQXKFGTQPVJG
UCOGFC[$WVUJGJCFVYQFKHHGTGPVV[RGUQHRTQEGFWTGU5JGJCFUWTIGTKGUCPF
UJGJCFFKCIPQUVKEVGUVU6JWUYGYQWNFEQWPVDQVJQHJGTUWTIGTKGUCUQPG
KPEKFGPVCPFJGTVJTGGFKCIPQUVKEVGUVUCUQPGKPEKFGPV5QYGçFJCXGVYQKPEKFGPVU
HQTVJCVQPGGPEQWPVGT(QTFTWIUYGEQWPVGCEJFQEVQTYTKVVGPRTGUETKRVKQPCU
QPG
0GZVNGVçUNQQMCVGPTQNNOGPV#EQWPVKUECRVWTGFHQTGCEJRQNKE[QTOGODGTHQT
GCEJOQPVJVJGRQNKE[QTOGODGTKUCEVKXG6JGPKVçUUWOOGFCPFVJGUWOKU
FKXKFGFD[HQTVJGCXGTCIGRQNKEKGUQTOGODGTUGZRQUGFKPVJGUGIOGPV9G
ECRVWTGGPTQNNOGPVPQVQPN[HQTVJGVQVCNDWVHQTGCEJQRVKQPCNEQXGTCIGUWEJCU
OCVGTPKV[FTWICPFFGPVCNUQVJCVVJGWPKVOGCUWTGUHQTGCEJQHVJGKTUGIOGPVUYKNN
DGDCUGFQPVJGRGQRNGYJQJCFVJGEQXGTCIG9GCTGUVKNNTGUGCTEJKPIEQTTGEV
OGPVCNJGCNVJCPFUWDUVCPEGCDWUGGPTQNNOGPVCPFYGçNNCFFVJCVYJGPVJCV
DGEQOGUCXCKNCDNG
(KPCNN[NGVçUNQQMCVVJGTGRQTVKPIQRVKQPU(QTUVCPFCTFTGRQTVUCPFCFJQECPCN[UKU
YGJCXGHNGZKDKNKV[KPYJCVMKPFQHFCVCYGRWNNHQTVJGTGRQTVU4GRQTVKPIQRVKQPU
CTGCTGCUKPYJKEJQWTEWUVQOGTU
CPFQWTEWUVQOGTUCTGOQUVN[KPVGTPCNEWUVQOGTU
RGQRNGKPOGFKECNOCPCIGOGPVRGQRNGKPEQTRQTCVGHKPCPEGCPFRGQRNGYJQCTG
DWKNFKPIPGVYQTMUECPUGNGEVYJCVFCVCVJG[YKUJVQUGG
(QTQWTFKUEWUUKQPNGVçUNQQMCVVJGGZCORNGQHCWVQOCVKEDCPMEJGEMRNCPUGIOGPV
YJKEJEQWNFDGCNKPGQHDWUKPGUU+VEQWNFDGCITQWRCTGIKQPCUVTCVGIKEDWUKPGUU
WPKVQTGXGPCJQURKVCNKHGPTQNNOGPVOGCPURCVKGPVUKPUVGCFQHOGODGTUQTRQNKEKGU
6JGPYGYQWNFQPN[TGRQTVVJGHCEKNKV[KPHQTOCVKQP%#45KUCU[UVGO+VçUPQVC
TGRQTV9GJCXGCNQVQHHNGZKDKNKV[VJGTG(QTGCEJUGIOGPVYGJCXG:;<PGVYQTM
7VKNK\CVKQP4GXKGY+UUWGU
;QWOC[YCPVVQNQQMCVVJGOGCUWTGUD[221KPFGOPKV[RQKPVQHUGTXKEGQT
*/1PGVYQTMUDWVVJGURNKVFQGUPçVJCXGVQDGPGVYQTMU+VEQWNFDGUQOGQVJGT
URNKVVJCVVJGEWUVQOGTFGUKTGU+PHCEVVJGTGEQWNFDGUGXGTCNQVJGTURNKVU6JKUKU
PQVLWUVCTGRQTVKVçUCU[UVGO
.GVçUNQQMCVVJGVKOGRGTKQF9GJCXGCNNVJGFCVCHQTUGTXKEGUKPEWTTGFKPVJG[GCT
CPFYJCVJCUDGGPRCKFVJTQWIJ/CTEJ6JGEWUVQOGTUVGNNWUYJCV
VJG[YCPV#PQVJGTQRVKQPYQWNFDGVQUGGENCKOURCKFKPCPFRWVPQ
TGUVTKEVKQPUQPYJGPVJG[YGTGKPEWTTGF+VçUWRVQVJGEWUVQOGT6JGTGçUVJGNGXGN
QHENCKOUFGUKTGF6JGTGSWKTGOGPVUHQTVJKURCTVKEWNCT%#45TGRQTVYGTGVQKPENWFG
EQXGTGFEJCTIGUVJCVYGTGPQVTGFWEGFHQTVJGFGFWEVKDNGUEQRC[OGPVUCPFEQ
KPUWTCPEGRCKFD[VJGRQNKE[JQNFGT#UCPQVJGTQRVKQPVJGTGSWGUVGTEQWNFJCXG
CUMGFHQTVJGENCKOUVJCVVJGEQORCP[RCKFCHVGTDGPGHKVFGUKIP5QFGRGPFKPIQP
YJCVVJGEWUVQOGTQTYJCVYG
YGçTGQWTQYPEWUVQOGTUOCP[VKOGUCTGVT[KPIVQ
FQYGECPTGSWGUVNGXGNUQHENCKOUVJGFCVGUCPFVJGUGIOGPVUYGYCPVVQNQQMCV
.GVçUNQQMCVJQY%#45ECPDGWUGF9GWUWCNN[RTQFWEG%#45TGRQTVUHQTOWNVK
RNGVKOGRGTKQFUCPFNQQMCVVTGPFU6CDNGKUCUVTGCONKPGFKPRCVKGPVHCEKNKV[
GZCORNGHTQOVYQTGRQTVUQHVYQ[GCTU
TABLE 1
EXAMPLE: TRENDS
Days per 1,000
Medical
Surgical
Maternity
Mental health
Substance abuse
Subtotals
4%
3
0
51
58
8
Admissions per 1,000
17%
11
9
57
67
4
ALOS (Days)
11%
10
8
6
4
12
6JGOGFKECNCPFUWTIKECNRGTEGPVCIGUOKIJVDGCYCTPKPI6JGFGETGCUGKPVJG
CXGTCIGNGPIVJQHUVC[U
VJGCPFCTGOCVEJGFD[CPKPETGCUGKPVJGUG
CFOKUUKQPUCPF6JKUYCUUQOGTGCNFCVC#TGRTQXKFGTUKPETGCUKPI
CFOKUUKQPUVQEQWPVGTCEVVJGRTQITGUUYGJCXGOCFGKPTGFWEKPIQWTCXGTCIGNGPIVJ
QHUVC[YKVJCNNQWTECUGOCPCIGOGPVRTQITCOU!9JCVçUIQKPIQPJGTG!#U[QWECP
UGGVJGTGFWEVKQPUKPVJGCXGTCIGNGPIVJQHUVC[HQTUWTIKECNOQTGVJCPQHHUGVVJG
KPETGCUGKPCFOKUUKQPU9GCNUQUGGUQOGTGFWEVKQPKPFC[URGTVJQWUCPFOGODGTU
CV$WVVJGKPETGCUGFCFOKUUKQPUOQTGVJCPQHHUGVUVJGTGFWEVKQPKPCXGTCIG
NGPIVJQHUVC[CPFVJGTGYCUCPKPETGCUGKPVJGFC[URGTVJQWUCPFOGODGTUQH
HQTOGFKECN(QTOCVGTPKV[OQTGDKTVJU
YJKEJYGJCXGPQEQPVTQNQXGTYGTGQHHUGV
D[TGFWEVKQPUKPVJGNGPIVJQHUVC[6JKUTGUWNVGFKPPQKPETGCUGKPQWTFC[URGT
VJQWUCPFOGODGTU
4'%14&8QNWOG
(KPCNN[UVTKEVOCPCIGOGPVDTQWIJVKPITGCVTGFWEVKQPUKPOGPVCNJGCNVJCPFUWD
UVCPEGCDWUGCFOKUUKQPUCPFFC[U#U[QWECPUGGVJGTGOCKPKPIRCVKGPVUYGTGVJG
QPGUYKVJVJGOQTGUGXGTGJGCNVJRTQDNGOUCPFVJGCXGTCIGNGPIVJQHUVC[KP
ETGCUGF9GCTGPQYYQTMKPIQPOCMKPIVJG%#45TGRQTVUHGGFCPKPVGTCEVKXG
OQFGNUQVJCVOCPCIGOGPVECPETGCVGHWVWTGéYJCVKHêUEGPCTKQU6JGJQURKVCN
PGIQVKCVQTUECPUWRRN[VJGKTRTQLGEVKQPUQHJQURKVCNEQUVURGTFC[QTRGTCFOKUUKQP
CPFRGQRNGKPOGFKECNOCPCIGOGPVECPUWRRN[RTQLGEVGFTGFWEVKQPUKPFC[UQT
KPEKFGPVURGTVJQWUCPFOGODGTUCUCTGUWNVQHVJGKTWVKNK\CVKQPTGXKGYRTQITCOU
1PEGVJGUGKPRWVUHNQYVJTQWIJVJKUOQFGNYGECPUGGYJGVJGTVJGDQVVQONKPG
TGUWNVUQPVJGDQVVQOQHVJG%#45TGRQTVUCITGGYKVJVJGHKPCPEKCNVCTIGVU9JGP
VJG[FQPçVCITGGYKVJVJGHKPCPEKCNVCTIGVU
UQOGVKOGUUGVD[OQTGEQTRQTCVGV[RGUQH
HQNMUVJCVCTGPçVKPVJGPKVV[ITKVV[QHVJKUVJKUCNGTVUEQTRQTCVGOCPCIGOGPVVQNQQM
HQTQVJGTYC[UVQOGGVHKPCPEKCNVCTIGVU
/T&QDUQP6JCVYCUXGT[KPVGTGUVKPI9GYCPVGFVQDCNCPEGVJKURCPGNCPFJCXG
UQOGDQF[HTQOCEQORCP[VJCVYQWNFIKXG[QWUQOGTGCNKPHQTOCVKQPVQIQQP
%QPUWNVCPVUYKNNVGPFVQVCNMKPOQTGIGPGTCNKVKGUCU[QWRTQDCDN[MPQYDWV$TGPV
CPF+CTGIQKPIVQVT[VQDGCUURGEKHKECURQUUKDNG
+çOIQKPIVQUVCTVD[VCNMKPICNKVVNGDKVCDQWVYJCVCPQRVKOWOOQFGNKUDQVJHTQOC
FGNKXGT[UVCPFRQKPVCPFVJGCEVWCTKCNUVCPFRQKPV#HVGTVJCV+çOIQKPIVQUC[CHGY
YQTFUCDQWVVJG/4*GCNVJECTG/CPCIGOGPV)WKFGNKPGULWUVUQRGQRNGWPFGT
UVCPFYJCVVJG[CTG+çNNVCNMCDKVCDQWVOGCUWTGOGPVCPFVJGPVJGVQRKEUVJCV
PQDQF[GNUGYCPVGFVQVCNMCDQWVåWPFGTWVKNK\CVKQPNGIKUNCVKQPCPFTGIWNCVKQP
(KPCNN[+çNNOCMGCEQWRNGQHEQOOGPVUCDQWVVJGHWVWTGDGHQTGVWTPKPIKVQXGTVQ
$TGPVYJQYKNNVCNMOQTGCDQWVVJGHWVWTG
9JGPYGUC[VJGVGTOQRVKOWOOQFGNUQOGVKOGURGQRNGVJKPMQHVJCVKPVGTOUQH
YJCVVJGFGNKXGT[U[UVGOOQFGNKUIQKPIVQNQQMNKMG5QOGVKOGURGQRNGVJKPMQHKV
KPVGTOUQHCPCEVWCTKCNEQUVOQFGNVJCVKUUGVCVQRVKOCNQTXGT[NQYWVKNK\CVKQP
TGUWNVU+IWGUUYGçXGVTKGFVQOCMGVJKUFKUVKPEVKQPYJGPYGVCNMRCTVKEWNCTN[VQ
RTQXKFGTENKGPVUYJQFQPçVWPFGTUVCPFCNQVCDQWVVJGCEVWCTKCNYQTM6JGRQKPV+
CNYC[UVT[VQOCMGKUCPCEVWCT[ECPCUUWOGCP[VJKPIVJCVJGQTUJGYCPVUVQKP
VGTOUQHWVKNK\CVKQPDWVYGçTGPQVIQKPIVQDGVJGQPGUQWVVJGTGOCPCIKPIVJGECTG
5QOGDQF[OWUVIQQWVCPFOCPCIGVJGECTGCPFCEVWCNN[OCMGVJGUGVJKPIU
JCRRGP+VçUPQVCUKH[QWECPEQPXKPEGOGVQRWVCPCUUWORVKQPKP[QWTRTKEKPI
VJCVçUIQKPIVQOCMGKVVWTPQWVVQDGVTWG1PGQHQWTWVKNK\CVKQPTGXKGYPWTUGUKP
QPGQHQWTQHHKEGUVJCV+YQTMYKVJUC[UVJCVCEVWCTKGUVGNN[QWYJGTG[QWPGGFVQDG
HTQOCEQORGVKVKXGCPFWVKNK\CVKQPUVCPFRQKPVCPFVJGPVJGPWTUGUCPFFQEVQTUVJCV
7VKNK\CVKQP4GXKGY+UUWGU
YQTMQPVJGWVKNK\CVKQPUKFGIQQWVCPFVGNN[QWJQY[QWECPIGVVJGTGQTYJCV[QW
JCXGVQFQVQIGVVJGTG
1PGQHVJGMG[VJKPIUYGVCNMCDQWVYKVJTGICTFVQVJKUKUYJCVYGECNNKPHTCUVTWE
VWTGCPF+çOPQVIQKPIVQUC[OWEJCDQWVVJGUGDWVVJKUKUCEVWCNN[CNKUVQHPGGFGF
VJKPIUHTQOCTGUGCTEJTGRQTV+VçUIGCTGFVQJGNRKPIRTKOCT[OGFKECNITQWRU
WPFGTUVCPFVJGMKPFUQHVJKPIUVJCVVJG[çTGIQKPIVQPGGFVQIGVKPVQCPFJCXG
CXCKNCDNGKHVJG[çTGIQKPIVQGHHGEVKXGN[OCPCIGECTG/QUVQH[QWYJQYQWNFDG
EQOKPIHTQOCPKPUWTCPEGEQORCP[UVCPFRQKPVYQWNFDGHCOKNKCTYKVJVJGPGGFHQT
CNNQHVJGUGVJKPIUDWV[QWçFDGUWTRTKUGFCVJQYOWEJUQOGQHVJGRTQXKFGTITQWRU
FQPçVVJKPMCDQWVKVDGHQTGVJG[IGVKPVQKV
(TQOVJGKPHTCUVTWEVWTGUVCPFRQKPVKVçUTGCNN[COCVVGTQHJCXKPIVJGU[UVGOUåD[
U[UVGOU+FQPçVLWUVOGCPEQORWVGTU[UVGOU+OGCPCP[V[RGQHU[UVGOUåCPFVJG
CDKNKV[VQDGCDNGVQOCPCIGVJGECTG9GCNUQDGNKGXGQHEQWTUGVJCVHKPCPEKCN
KPEGPVKXGUCTGXGT[MG[VJQWIJYJGP+IGVVQVJGWPFGTWVKNK\CVKQPUGEVKQPCPFVJG
TGIWNCVKQPCPFNGIKUNCVKQPUGEVKQP[QWçNNUGGVJCVVJGHKPCPEKCNKPEGPVKXGOC[DG
EQOKPIWPFGTKPETGCUKPIUETWVKP[+VçUXGT[KORQTVCPVVQOCMGUWTGHKPCPEKCN
KPEGPVKXGUCTGNKPGFWRRTQRGTN[CPFHKVKPYKVJVJGKPHTCUVTWEVWTG
6JGTGçUCHQTOWNC+WUGYKVJRTQXKFGTITQWRUVQVT[VQWPNQEMVJGCEVWCTKCNDNCEMDQZ
+VGNNVJGOVJGCEVWCTKCNRCTVKUTGCNN[UKORNG;QWJCXGQPGUKORNGHQTOWNC[QW
JCXGVQMPQY7VKNK\CVKQPVKOGUEJCTIGFKXKFGFD[IKXGU[QWRGTOGODGTRGT
OQPVJ1HEQWTUGKHVJGWVKNK\CVKQPKUGZRTGUUGFKPVGTOUQHWVKNK\CVKQPRGTVJQW
UCPF[QWTGCNN[JCXGVQFKXKFGD[+WUWCNN[NQUGGXGT[DQF[D[VJGPCPF+
IQQPVQRQKPVQWVVJCVVJGTGCTGNQVUQHFKHHGTGPVKORCEVUQPVJGWVKNK\CVKQPCIGUGZ
CTGC6JGUGCTGCNNVJKPIUVJCVCUCEVWCTKGUYGçTGHCOKNKCTYKVJ6JGTGCTGCFLWUV
OGPVUQPEJCTIGDWV+FQJQRGVJCVD[OCMKPIRGQRNGUGGVJCVVJGDCUKECTKVJOGVKE
KUSWKVGUKORNGVJCVVJGTGçUUQOGOGCPKPIKPVJCV
%JCTVKUFGUKIPGFVQUJQYVJGFKTGEVKQPKPYJKEJOQUVQHVJGOQXGOGPVUCTG
IQKPICUYGOQXGVQCPQRVKOWOOQFGN6JGHKTUVCTGCVJGKPRCVKGPVKUHCKTN[
QDXKQWU+PRCVKGPVWVKNK\CVKQPJCUDGGPIQKPIFQYP6JGGHHGEVQHOCPCIGFECTGKU
VQFGETGCUGVJCV1PVJGEJCTIGUKFGYGJCXGVYQGHHGEVUVJCVEQWPVGTCEVGCEJ
QVJGT1PGKUVJCV[QWYQWNFGZRGEVVQDGIGVVKPIOQTGCPFOQTGHCXQTCDNG
RTQXKFGTFKUEQWPVUCUYGIQHQTYCTFKPVKOGCPFIGVVQCITGCVGTFGITGGQHJGCNVJ
ECTGOCPCIGOGPVDWVIQKPICICKPUVVJCVKUKPVGPUKV[+VKPETGCUGUCU[QWTGFWEGVJG
FC[UNGCXKPIRGQRNGYJQCTGUKEMGTCPFYJQPGGFOQTGTGUQWTEGU5QVJGEJCTIGU
VGPFVQIQWR1HEQWTUGVJKUECPXCT[FGRGPFKPIQPYJCV[QWTHKPCPEKCNCTTCPIG
OGPVKUYKVJVJGJQURKVCNU9GYQTMQPCPWODGTQHECUGUYJGTGVJGJQURKVCNUIKXG
RGTFKGOCTTCPIGOGPVUQTCOQWPVURGTFC[VJCVYQWNFDGDKNNGF6JGVTKEM[RCTV
4'%14&8QNWOG
CDQWVDWKNFKPIVJCVKPVQVJGCEVWCTKCNEQUVOQFGNKUVJCVQHVGPYJCVVJGRGTFKGOKU
HQTOGFKECNQTUWTIKECNYKNNDGUWDLGEVVQUQOGUQTVQHQWVNKGTRTQXKUKQP
CHART 1
DIRECTION OF UTILIZATION
%NCKOUCDQXGCEGTVCKPCOQWPVYKNNIQVQUQOGRGTEGPVCIGQHEJCTIGUCPFUKOK
NCTN[VJGTGçUUQOGVKOGUCUGRCTCVGEJCTIGNGXGNHQTVJGKPVGPUKXGECTGWPKV
+%7#U
[QWçNNUGGNCVGTYGDGNKGXGVJCVOQTGCPFOQTGQHVJGECTGKUIQKPIVQDGKPVGPUKXG
ECTG6JGTGHQTGVJGOKZQHVJQUGVJKPIUECPEJCPIG+PHCEVYGJCFQPGENKGPVVJCV
GPFGFWRYKVJQXGTQHVJGKTFC[UCU+%7CUVJG[OCPCIGFVJGECTGVKIJVGTCPF
JCFCRGTFKGOCTTCPIGOGPVYKVJVJGJQURKVCNU5QOGQHVJCVOC[JCXGDGGP
ICOKPIQPVJGJQURKVCNUKFG+çOPQVUWTG
1PVJGQWVRCVKGPVUKFGYGUGGVJGCTTQYUIQKPIKPQRRQUKVGFKTGEVKQPUDGECWUG
ENGCTN[[QWFQOQTGUGTXKEGUQWVRCVKGPVCU[QWFTKXGVJKPIUHTQOVJGKPRCVKGPV
6JCVçUVJGWRCTTQY#VVJGUCOGVKOGYGYCPVVQDGOCPCIKPIVJGQWVRCVKGPVECTG
DGVVGTUQVJCVçUVJGFQYPCTTQY6JGCEVWCTKCNVTKEMKUHKIWTKPIQWVJQYVJQUGVYQ
DCNCPEGKPVJGRCTVKEWNCTOQFGNVJCV[QWçTGNQQMKPICV;QWYCPVRTQXKFGTFKU
EQWPVUDWV[QWGZRGEVITGCVGTKPVGPUKV[+VYCUKPVGTGUVKPIVQOGCU+VJQWIJVCDQWV
KVYJGP+RWVVJKUEJCTVVQIGVJGTVJCVVJGKPVGPUKV[KPCNNQHVJGECUGUIQGUWR;QWF
VJKPMOC[DGVJGTGYQWNFDGUQOGCTGCVJCVYQWNFPçVDGECWUGYJCVYGçTGTGCNN[
FQKPIKUVT[KPIVQMGGRUQOGRGQRNGQWVQHVJGU[UVGOYJQFQPçVTGCNN[PGGFECTG
$WVCU[QWVT[VQIGVVJGRTKOCT[ECTGFQEVQTUVQFQOQTGQTFQUQOGVJKPIUC
URGEKCNKUVFKFVJCVFTKXGUWRVJGKTKPVGPUKV[#U[QWVCMGUGTXKEGUCYC[HTQOVJG
7VKNK\CVKQP4GXKGY+UUWGU
URGEKCNKUVUYJQYGTGNGUUKPVGPUKXGURGEKCNV[KPVGPUKV[IQGUWR5QKVUGGOUVQDG
CNYC[UCPKPETGCUGVJQWIJVJCVKUUQOGYJCVEQWPVGTKPVWKVKXGVQOGCVNGCUV
;QWGZRGEVRTKOCT[ECTGWVKNK\CVKQPVQIQWRCU[QWFTKXGOQTGUGTXKEGUVJGTG
0QYVJKUFQGUPçVOGCP[QWYCPVWPPGEGUUCT[QHHKEGXKUKVUDWV[QWFQYCPVVJG
RTKOCT[ECTGFQEVQTUFQKPIOQTGVJCPVJG[FKFKPVJGRCUVCPFVJGURGEKCNV[ECTG
IQKPIFQYP#PFVJGPHKPCNN[O[HCXQTKVGVQRKECU<QGUCKFKUJQOGJGCNVJECTG
KVçUCXGT[UOCNNRGTEGPVCIGKPOQUVEQOOGTEKCNEQUVOQFGNUTKIJVPQYDWVQPGYG
GZRGEVVQITQYCNQV#EVWCNN[KVçUCNTGCF[UKIPKHKECPVKP/GFKECTGOQFGNU9JCV
JCRRGPUKPJQOGJGCNVJKU[QWGZRGEVVJGECUGUVQIQWRDWVCU[QWOCPCIGVJG
JQOGJGCNVJECTGKVUGNH[QWGZRGEVVJGXKUKVURGTECUGVQIQFQYP#ICKPKPVGTOU
QHVQVCNXKUKVURGTVJQWUCPFRQRWNCVKQPKVçUCOKZVWTGCPF[QWECPçVDGUWTGGZCEVN[
JQYKVçNNIQ
6JGTGUWNVQHCNNQHVJKUKUVJCVVJGTGCTGOCP[XCTKCDNGUCPFOWEJLWFIOGPVTG
SWKTGF1XGTVJGPGZVHGY[GCTUYGçTGCRVVQUGGCNQVQHXCTKCVKQPHTQORNCPVQRNCP
CPFGXGPHTQOCEVWCT[VQCEVWCT[KPYJCVYGXKGYCUVJGQRVKOWOOQFGNDWVVJQUG
CTGUQOGQHVJGEQPUKFGTCVKQPU
6JG5QEKGV[EGTVCKPN[YCTPURGQRNGCICKPUVFQKPICP[VJKPIVJCVECPDGEQPUVTWGFCU
CPCFXGTVKUGOGPVCPF+EGTVCKPN[FQPçVYCPVVJKUVQDGEQPUVTWGFCUCPCFXGTVKUG
OGPVD[CP[OGCPU+DGNKGXGVJCVVJG/4*GCNVJECTG/CPCIGOGPV)WKFGNKPGU
CTGDGKPIWUGFOQTGCPFVCNMGFCDQWVOQTG+VJQWIJVKVYQWNFDGKORQTVCPVVQUC[
CHGYYQTFUVJCV+XKGYCUOQTGGFWECVKQPCNCDQWVYJCVVJG[CTGCPFGXGPOQTG
KORQTVCPVN[YJCVVJG[CTGPQV#VQWT/4*GCNVJ(QTWOYGTGEGPVN[JCFC
TGRTGUGPVCVKXGHTQOVJG#OGTKECP/GFKECN#UUQEKCVKQP
#/#QPCRCPGNYKVJ&T
&KEM&Q[NGYJQçUVJGHCVJGTQHVJG/4*GCNVJECTG/CPCIGOGPV)WKFGNKPGU6JG
IW[HTQOVJG#/#MGRVUC[KPIYGNNVJGUGCTGCEVWCTKGURWVVKPIQWVVJGUGVJKPIU
CPF&Q[NGOWUVJCXGUCKFCJWPFTGFFKHHGTGPVVKOGUPQFQEVQTUFKFVJGUGPQV
CEVWCTKGU5QVJCVçUQPGKORQTVCPVRQKPV6JG[TGCNN[FCVGDCEMVQYJGP&T
&KEM&Q[NGYCUYKVJCJQURKVCNU[UVGOKP5CP&KGIQCPFUVCTVGFFGXGNQRKPIVJGO
5QOGVKOGKPVJGTGJGUVCTVGFYQTMKPIYKVJ&CXG#ZGPGCPF&GPPKU*WNGVCEVWCT
KGUKP/4çU5GCVVNGQHHKEGCPFVJGTGUWNVJCUDGGPVJG*GCNVJECTG/CPCIGOGPV
)WKFGNKPGU6JG[çTGCNUQPQVVQDGEQPHWUGFYKVJVJG/4*GCNVJ%QUV)WKFGNKPGU
YJKEJCTGOQTGV[RKECNCEVWCTKCNFCVCVJCV[QWYQWNFGZRGEVVQUGGEQOKPIHTQOQWT
HKTO
9GFQPçVTGEQOOGPFVJCVVJG*GCNVJECTG/CPCIGOGPV)WKFGNKPGUDGWUGFHQT
NGPIVJQHUVC[CUUKIPOGPVVJQWIJVJG[CTGKPUQOGECUGU6JG[TGTGCNN[IGCTGFVQ
OCPCIGVJGECTGCPFRNCPPKPIRTQCEVKXGN[TCVJGTVJCPTGCEVKPIVQYJCVJCRRGPU+çNN
UC[OQTGCDQWVVJCVKPCOKPWVGDWVVJG[CTGENGCTN[EQPEGTPGFYKVJVJGJGCNVJECTG
OCPCIGOGPVPQVVJGHKPCPEKPI
4'%14&8QNWOG
9GCNUQUGGRGQRNGEQPHWUGFCPFUC[KPIVJCVYJCVGXGTKUKPVJG/4*GCNVJECTG
/CPCIGOGPV)WKFGNKPGUOGCPUYJCVV[RGUQHEQXGTCIGU[QWIGVCPFJQYOCP[
FC[U[QWUJQWNFDGCNNQYGFHQTOCVGTPKV[+VçUPQVVJCVCVCNN+VçUTGCNN[JQYVQ
OCPCIGVJGECTG+VçUDCUGFQPVJGWPEQORNKECVGFRCVKGPV&T&Q[NGUCKFVJCV
YJGPGXGT[QWUKVFQYPYKVJCITQWRQHFQEVQTUVJG[UVCTVVCNMKPICDQWVVJGEQORNK
ECVGFRCVKGPVYJQFKFPçVOGGVEGTVCKPETKVGTKCVJG[JCFVQMGGRVJGRCVKGPVKPVJG
JQURKVCNHQTZPWODGTQHFC[UCPFUQCUJQTVGTNGPIVJQHUVC[FKFPçVYQTM6QIGV
CYC[HTQOCNNVJCVJGUCKFNGVçURNCPHQTVJGJGCNVJKGUVRGQRNGVJGRGQRNGYJQWUG
VJGHGYGUVTGUQWTEGUHQTCP[IKXGPRTQEGFWTGVJGQPGUYJQFQCUYGNNCUYGJQRG
CPFYJQJCXGPQEQORNKECVKQPU5QVJCVçUYJCVVJGRNCPUCTG1DXKQWUN[VJGTGCTG
IQKPIVQDGUQOGYJQJCXGEQORNKECVKQPUCPFFQPçVHKVVJCVFGHKPKVKQP+VçUDCUGFQP
DGUVRTCEVKEGUCPFEJCTVTGXKGYU
6JG/4FQEVQTUCPFPWTUGUJCXGFQPGUQOGQTOQTGEJCTVTGXKGYUCPF
VJCVçUYJCVVJGUGCTGFGXGNQRGFHTQO6JG[NQQMGFHQTWPPGEGUUCT[FC[UCPFYJCV
VJG[HQWPFYCUVJCVKPQHVJGWPPGEGUUCT[FC[UVJGUKVWCVKQPYCUVJCVVJG
FQEVQTUKORN[FKFPçVUGPFVJGRCVKGPVJQOGYJGPJGQTUJGUJQWNFJCXG6YGPV[
RGTEGPVQHVJGWPPGEGUUCT[FC[UTGUWNVGFHTQOFGNC[UKPUGTXKEG;QWYGTGUEJGF
WNGFVQIGVCEGTVCKPMKPFQH:TC[CPFKVFKFPçVJCRRGPQP/QPFC[+VJCRRGPGFQP
6WGUFC[5QVJGTGYCUCPWPPGEGUUCT[FC[KPVJGJQURKVCN6JCVçUPQVSWCNKV[ECTG
3WCNKV[ECTGKUOCMKPIUWTG[QWIGVVJGUGTXKEGQPVJGFC[KVçUOQUVDGPGHKEKCNCPF
[QWIGVUGPVJQOGCVVJGVKOG[QWçTGTGCF[VQIQJQOG+PVJCVUGPUGVJGTGçUPQ
FKUETGRCPE[QTPQFKUVKPEVKQPDGVYGGPOCPCIGFECTGCPFSWCNKV[ECTG6JG[çXGCNUQ
HQWPFVJCVVJGOQUVEQOOQPPWODGTQHWPPGEGUUCT[FC[UKUQPGCPFKVTGUWNVUCNQV
KVUGGOUHTQOFQEVQTUçRTCEVKEGUQHOCMKPITQWPFUCVCO6JGRCVKGPVJCULWUV
CYCMGPGFKUMKPFQHITQII[CPFVJGFQEVQTECPçVVGNNYJGVJGTJGQTUJGECPIQ
JQOG[GVQTPQV$WVKHVJGFQEVQTJCFDGGPVJGTGCVQTKVRTQDCDN[
YQWNFJCXGDGGPQDXKQWUVJCVVJGRCVKGPVEQWNFJCXGIQPGJQOG
0QY+YCPVVQFKUEWUUQPGQHVJGUG*GCNVJECTG/CPCIGOGPV)WKFGNKPGU1PG
GZCORNGKUYJCVYGECNNCPQRVKOCNTGEQXGT[IWKFGNKPGHQTCPCRRGPFGEVQO[YKVJ
UQOGEQORNKECVKQPU6JKUKUPçVCEVWCTKCNKVçUOGFKECNN[QTKGPVGF+VçUTGCNN[UC[KPI
YJCVVJKPIUUJQWNFDGFQPGHQTYJCVRCVKGPVUQPYJCVFC[UCICKPTGOGODGTKPIVJCV
VJG[çTGVJGWPEQORNKECVGFRCVKGPVU&C[VJTGGUC[UFKUEJCTIGYKVJJQOGJGCNVJ
ECTGHQTFTCKPQTYQWPFECTGCUPGGFGF1DXKQWUN[KH[QWçTGKPCTWTCNJQURKVCN
CPFVJGTGçUPQJQOGJGCNVJECTGCXCKNCDNGCVCNNVJCVECPçVJCRRGP1HVGPRGQRNG
OCMGCTIWOGPVUNKMGVJGQPGU+OGPVKQPGFGCTNKGTCDQWVOCVGTPKV[6JGOQVJGT
PGGFUVJKUQTVJGOQVJGTPGGFUVJCV+PCNQVQHECUGUVJCVECPDGRTQXKFGFVJTQWIJ
JQOGECTGCNQVEJGCRGTDWVVJGJQOGECTGJCUVQDGVJGTGCPFJCUVQDGCXCKNCDNG
6JGYJQNGKFGCQHVJKUKUVQRTQCEVKXGN[RNCPYJCVUJQWNFJCRRGPQPGXGT[IKXGP
FC[TCVJGTVJCPTGCEVVQYJCVFKFJCRRGP+PVJGQRVKOCNCEVWCTKCNOQFGNUVJCVYG
FQDCUGFQPVJKUYGCUUWOGUQOGRGTEGPVCIGQHECUGUCTGEQORNKECVGFQHEQWTUG
7VKNK\CVKQP4GXKGY+UUWGU
5QVJGPWODGTU+çNNUJQYKPVGTOUQHFC[URGTVJQWUCPFFQCUUWOGUQOGOKZQH
EQORNKECVGFRCVKGPVUYKVJNQPIGTNGPIVJUQHUVC[
,WUVVQENQUGQWVVJKUUGEVKQPCNKUVQHVJGFKHHGTGPV)WKFGNKPGUVJCVGZKUVTKIJVPQYQT
CTGFWGQWVCVCP[OQOGPVKUUJQYPDGNQY/CP[QHVJGUGXQNWOGUJCXGVJKPIU
QVJGTVJCPVJQUGQRVKOCNTGEQXGT[IWKFGNKPGUDWV+FKFPçVYCPVVQIQKPVQCNQVQH
VJCV5QVJGOCKPKFGCUCTGVJCVVJG[çTGENKPKECNN[QTKGPVGFPQVCEVWCTKCNN[QTKGPVGF
VJQWIJVJGTGKUUQOGDNGPFKPIQHDQVJ6JG[CTGPQVWUGFVQFGHKPGYJCVEQXGTCIG
UJQWNFDGDWVEQWNFDGWUGFVQOCPCIGVJGECTG
TABLE 2
MILLIMAN & ROBERTSON, INC. HEALTH CARE GUIDELINES
Vol. 1 - Inpatient and Surgical Care
Vol. 2 - Return-to-Work Planning
Vol. 3 - Ambulatory Care Guidelines
Vol. 4 - Case Management: Home Care
Vol. 5 - Primary Care and Pharmacy
Vol. 6 - Case Management: Non-acute Levels of Care
Vol. 7 - Workers’ Compensation
+PO[PGZVUGEVKQP+YCPVGFVQVCNMCNKVVNGDKVCDQWVOKUVCMGUVJCVCTGOCFGKP
OGCUWTKPIWVKNK\CVKQPTGXKGYTGUWNVU+VJKPM+çXGUGGPOQTGOKUVCMGUOCFGVJCP
IQQFU[UVGOU6JGU[UVGO<QGURQMGCDQWVEGTVCKPN[NQQMGFNKMGCIQQFU[UVGO
+JCXGNKUVGFHKXGEQOOQPOKUVCMGU9KVJKPVJG%#45U[UVGOVJGWUGTD[FGHKPKPI
VJKPIUEQWNFOCMGUQOGQHVJGUGOKUVCMGUKHJGQTUJGYCPVGFVQDWVKVYQWNFDG
VJGWUGTçUOKUVCMGCPFEGTVCKPN[PQVVJGU[UVGOçU0QYDGHQTG+NKUVVJGOKUVCMGU+
FKFYCPVVQOGPVKQPQPGVJKPICDQWVVJGNCEMQHRWDNKEWPFGTUVCPFKPIQHCXGTCIGU
6JGTGYCUUQOGDQF[QPVJGPGYUVCNMKPICDQWVVJG1N[ORKEUCPFJQYJQVKVYCU
IQKPIVQDG*GUCKFVJCVVJKURCTVKEWNCT[GCTVJGTGYCUCEJCPEGVJGCXGTCIG
VGORGTCVWTGYQWNFDGITGCVGTVJCPCXGTCIGCPF+MKPFQHXKGYGFVJCVOQUV[GCTU
VJGTGçUCEJCPEGKVçFDGITGCVGTCPFPQVDWVOC[DGVJCVçUVJGFKHHGTGPEG
DGVYGGPOGCPCPFOGFKCPQTUQOGVJKPI*GOCFGKVUGGONKMGVJCVYCUDKIPGYU
#P[YC[VJGUGCTGHKXGEQOOQPOKUVCMGUVJCV+çXGUGGP1PGVJCV+çXGUGGPQHVGP
VGPFUVQTGUWNVHTQORGQRNGYJQCTGVT[KPIVQOCMGVJGWVKNK\CVKQPTGXKGYTGUWNVU
NQQMIQQF6JGKTLQDKUVQUGNNVJGSWCNKV[QHVJGWVKNK\CVKQPTGXKGYRTQITCO#
EQOOQPQPGKUVQVCMGUQOGRCUVRGTKQFCPFVJGPRTQLGEVVJGWVKNK\CVKQPHQTYCTFD[
WUKPICPKPETGCUKPIWVKNK\CVKQPVTGPF6JGPEQORCTG[QWTEWTTGPVWVKNK\CVKQPVQKV
CPFUC[VJCVDGECWUGVJGEWTTGPVKUNQYGTVJCPVJGRTQLGEVGFVJCVçUCRQUKVKXGTGUWNV
HTQO[QWTWVKNK\CVKQPTGXKGYRTQITCO1HEQWTUGKH[QWçTGWUKPICPWRYCTFVTGPF
QPJQURKVCNFC[UVJCVYQWNFPQVDGXGT[CEEWTCVG1PUQOGVJKPIUKVOKIJVDG1H
4'%14&8QNWOG
EQWTUGKVçUCNYC[UFKHHKEWNVVQHKIWTGQWVYJCVYQWNFJCXGJCRRGPGFKPVJGCDUGPEG
QHCPCEVKQP[QWVQQM
#UGEQPFOKUVCMGVJCV+TCPKPVQYCUYJGPUQOGDQF[YCUVCMKPICNGPIVJQHUVC[
FKUVTKDWVKQPVCDNGVJCVYCUUGVQWVKPRGTEGPVKNGUCPFVJGPEQORCTKPIVJGKTCEVWCN
NGPIVJQHUVC[VQVJG6JG[UCKFVJG[YGTGDGKPIEQPUGTXCVKXGDGECWUGVJG[
WUGFVJGVJTCVJGTVJCPWUKPIVJGVJDWVKHVJGKTNGPIVJQHUVC[YCUUJQTVGTVJCP
VJGVJG[YGTGUCXKPIFC[UYJGTGCUKHVJG[YGTGITGCVGTVJCPVJGOGCPDWV
NGUUVJCPVJGVJVJG[YGTGCEVWCNN[EQUVKPIFC[U
#PQVJGTQPG+çXGUGGPKUVQCVVTKDWVGCNNQHVJGEJCPIGVQCEVKQPUVJCV[QWçXGVCMGP
+PCPGPXKTQPOGPVNKMGYGçXGJCFYKVJJQURKVCNFC[UFGETGCUKPICP[YC[VJCVçUQHVGP
PQVVJGECUGDGECWUGOC[DGVJGFC[UYQWNFJCXGFGETGCUGFPQOCVVGTYJCV[QW
FKF#PQVJGTOKUVCMGVJCVçUGCU[VQOCMGQHEQWTUGKUVQJCXGCFKHHGTGPVOKZQH
DWUKPGUUKPVJGVYQEGNNU[QWEQORCTGHTQOQPG[GCTVQVJGQVJGT#PFVJGPHKPCNN[
VJGTGçUVJGGXGTRQRWNCTRCKFXGTUWUKPEWTTGF
/[PGZVVQRKEKUWPFGTWVKNK\CVKQP9JGP+HKTUVUCYVJKUQPG+VJQWIJVYGNNVJCVçU
PQVOWEJQHCVQRKE9J[KUVJCVGXGPQPVJGTG!$WVVJGRGQRNGRNCPPKPIVJG
RTQITCOMPGYOQTGCDQWVKVVJCP+FKF#U+NQQMGFKPVQKVKVFQGUUGGONKMGVJKUKU
IQKPIVQDGCPKPETGCUKPIN[KORQTVCPVCTGCHQTRGQRNGKPVJGOCPCIGFECTGDWUKPGUU
+VTGCNN[VKGUKPVQSWCNKV[OCPCIGOGPVRTQITCOUCPFEQPEGTPUVJCVCTGEQOKPIHTQO
EQPUWOGTITQWRUCDQWVHKPCPEKCNKPEGPVKXGUVJCVIKXGRTQXKFGTUKPEGPVKXGUVQNQYGT
VJGWVKNK\CVKQP+VCNUQQEEWTUYJGP[QWJCXGECRKVCVKQPTGKODWTUGOGPV5QQPG
YC[QHFGCNKPIYKVJVJKUKUVQJCXGRCVKGPVUCVKUHCEVKQPUWTXG[UYJGTG[QWNQQM
ENQUGN[HQTCP[EQOOGPVUVJCVEQOGKPCDQWVUGTXKEGUVJCVRGTJCRUUJQWNFJCXG
DGGPTGPFGTGFCPFYGTGPçV
#PQVJGTYC[KUVQOQPKVQTTGCFOKUUKQPUCPFQVJGTCFXGTUGGXGPVUCPFVJGPJCXGKV
DGRCTVQHVJGOGFKECNTGXKGYRTQEGUUVQNQQMHQTWPFGTWVKNK\CVKQPCUYGNNCUQXGT
WVKNK\CVKQP6JCVECPKPXQNXG40UCPFVJGOGFKECNFKTGEVQT+VçUKORQTVCPVQH
EQWTUGVQIKXGHGGFDCEMVQVJGRTQXKFGTCPF+WPFGTUVCPFUQOGRNCPUCTGCEVWCNN[
NKPMKPIUQOGHKPCPEKCNKPEGPVKXGUVQCXQKFKPIVJKPIUNKMGWPFGTWVKNK\CVKQPCPFVQ
RCVKGPVUCVKUHCEVKQP
9JCVçUPQVWUGFCUEQOOQPN[DWVYKNNDGWUGFOQTGKPVJGHWVWTGYQWNFDG
UVCVKUVKECNRTQHKNGUåNQQMKPICVVJGWPFGTWVKNK\CVKQPTCVJGTVJCPLWUVVJGQXGTWVKNK\C
VKQPUKFG
(KPCNN[[QWECPFQENCKOEQFGUETGGPKPIHQTRCTVKEWNCTYGNNPGUUUGTXKEGUD[CIG
ITQWRUWEJCUOCOOQITCRJKGUHQTEGTVCKPGZRGEVGFCIGITQWRU;QWECPNQQMHQT
URGEKHKEEWTTGPVRTQEGFWTCNVGTOKPQNQI[EQFGUKPVJGENCKOUFCVC6JKUKUKORQTVCPV
7VKNK\CVKQP4GXKGY+UUWGU
HQTUWEJVJKPIUCU0CVKQPCN%QOOKVVGGHQT3WCNKV[#UUWTCPEGTGEQIPKVKQPCPFNGCFU
KPVQVJGPGZVVQRKENGIKUNCVKQPCPFTGIWNCVKQP+VYKNNCNUQDGEQOGKORQTVCPVWPFGT
VJG0#+%OQFGNKHVJCVçUCFQRVGFKPCPWODGTQHUVCVGU
6JGTGCTGVYQVJKPIU+YCPVGFVQVCNMCDQWVQPVJKUVQRKE1PGKUC%CNKHQTPKC
KPKVKCVKXGECNNGFVJG2CVKGPV2TQVGEVKQP#EV+FQPçVMPQYCNQVCDQWVVJKUQVJGTVJCP
YJCV+çXGTGCFKPVJGRTGUUDWVQPGQHVJGVJKPIU+çXGRKEMGFWRQPKUVJCVKVU
UWRRQUGFVQQRGTCVGCVPQEQUVVJCVKUKVçUEQUVPGWVTCNDWVKVçUIQKPIVQTGSWKTGC
UGEQPFQRKPKQPDGHQTGCP[ECTGECPDGFGPKGFYJKEJEQWNFDGHCKTN[HCTTGCEJKPI
+VçUUWRRQUGFVQDCTHKPCPEKCNKPEGPVKXGUVQRTQXKFGTU6JCVEQWNFDGXGT[HCT
TGCEJKPIRCTVKEWNCTN[KPVJG%CNKHQTPKCOCTMGV
1PGQHVJGYC[UKVçUIQKPIVQDGCDNGVQDGEQUVPGWVTCNIKXGPCNNVJQUGVJKPIUVJCV
YQWNFOCMGKVUQWPFFKHHKEWNVKUVJCVVJG[YKNNVCMGUQOGHGGUQWVQHVJGXCUVN[
QXGTRCKFEJKGHGZGEWVKXGQHHKEGTUCNCTKGUCEEQTFKPIVQVJGEQPUWOGTKUVUYJQCTG
RWUJKPIVJKUCVNGCUVCPFCNUQUQOGKPEQOGEQWNFDGTGCNN[IGPGTCVGFHTQOOGTIGTU
CPFCESWKUKVKQPUVJCVQEEWTKPVJGJGCNVJECTGHKGNF
6JG0#+%FTCHVOQFGNCPQVJGTXGTUKQPQHYJKEJYCUDTQWIJVQWVCVVJGOGGVKPIKP
,WPGFGCNUYKVJWVKNK\CVKQPTGXKGY+VFGHKPGUWVKNK\CVKQPTGXKGYCPFCPWODGTQH
QVJGTVJKPIU+çNNUJQY[QW+YKNNTGCFWVKNK\CVKQPTGXKGYYJKEJKUHCKTN[DTQCF
7VKNK\CVKQPTGXKGYOGCPUCUGVQHHQTOCNVGEJPKSWGUFGUKIPGFVQOQPK
VQTVJGWUGQHQTGXCNWCVGVJGENKPKECNPGEGUUKV[CRRTQRTKCVGPGUU
GHHKECE[QTGHHKEKGPE[QHJGCNVJECTGUGTXKEGURTQEGFWTGUQTUGVVKPIU
6GEJPKSWGUOC[KPENWFGCODWNCVQT[TGXKGYRTQURGEVKXGTGXKGY
UGEQPFQRKPKQPEGTVKHKECVKQPEQPEWTTGPVTGXKGYECUGOCPCIGOGPV
FKUEJCTIGRNCPPKPIQTTGVTQURGEVKXGTGXKGY
6JGPGZVFGHKPKVKQPKUVJCVQHCPCFXGTUGFGVGTOKPCVKQP
#FXGTUGFGVGTOKPCVKQPOGCPUCFGVGTOKPCVKQPD[CJGCNVJECTTKGTQTKVU
FGUKIPGGWVKNK\CVKQPTGXKGYQTICPK\CVKQPVJCVCPCFOKUUKQPCXCKNCDKNKV[
QHECTGEQPVKPWGFUVC[QTQVJGTJGCNVJECTGUGTXKEGJCUDGGPTGXKGYGF
CPFDCUGFWRQPVJGKPHQTOCVKQPRTQXKFGFFQGUPQVOGGVVJGJGCNVJ
ECTTKGTçUTGSWKTGOGPVUHQTOGFKECNPGEGUUKV[CRRTQRTKCVGPGUUJGCNVJ
ECTGUGVVKPINGXGNQHECTGQTGHHGEVKXGPGUUCPFVJGTGSWGUVGFUGTXKEGKU
VJGTGHQTGFGPKGFTGFWEGFQTVGTOKPCVGF
6JCVçUO[RGVRGGXGEQOKPIKPCICKPVJGTGDGECWUGYJCVYGçTGFGP[KPIYQWNFDG
HQTRC[OGPVQTEQXGTCIG9GPGXGTUC[VJCVVJGRGTUQPECPçVJCXGVJGUGTXKEG
6JG[CNYC[UECPFQVJCV
4'%14&8QNWOG
+VUGGOUNKMGQPGQHVJGVJTWUVUQHVJGNCYKUQWVNKPGFKPVJKURQTVKQP
#JGCNVJECTTKGTUJQWNFDGTGURQPUKDNGHQTOQPKVQTKPICNNWVKNK\CVKQP
CEVKXKVKGUECTTKGFQWVD[QTQPDGJCNHQHVJGJGCNVJECTTKGTCPFHQT
GPUWTKPIVJCVCNNTGSWKTGOGPVUQHVJKU#EVCPFCRRNKECDNGTGIWNCVKQPUCTG
OGV6JGJGCNVJECTTKGTUJCNNCNUQGPUWTGVJCVCRRTQRTKCVGRGTUQPPGN
JCXGQRGTCVKQPCNTGURQPUKDKNKV[HQTVJGEQPFWEVQHVJGJGCNVJECTTKGTçU
WVKNK\CVKQPTGXKGYRTQITCO
6JKUUGGOUVQDGFGUKIPGFVQRTGXGPVCDWUGUCPFVQRTGXGPVECTTKGTUHTQOFKUCXQY
KPICP[MPQYNGFIGQHYJCVçUIQKPIQPDGECWUGVJG[çXGUWDEQPVTCEVGFKV
1HKPVGTGUVVQ/4DGECWUGVJG*GCNVJECTG/CPCIGOGPV)WKFGNKPGUCTGDGKPI
WUGFKUVJGFGHKPKVKQPQHENKPKECNTGXKGYETKVGTKC
%NKPKECNTGXKGYETKVGTKCOGCPUVJGYTKVVGPUETGGPKPIRTQEGFWTGU
FGEKUKQPCDUVTCEVUENKPKECNRTQVQEQNUCPFRTCEVKEGIWKFGNKPGUWUGFD[
VJGJGCNVJECTTKGTVQFGVGTOKPGVJGPGEGUUKV[CPFCRRTQRTKCVGPGUUQH
JGCNVJECTGUGTXKEGU
#NCVGTRCTVUC[UVJCVCWVKNK\CVKQPTGXKGYRTQITCOOWUVDGDCUGFQPFQEWOGPVGF
ENKPKECNTGXKGYETKVGTKCDCUGFQPUQWPFENKPKECNGXKFGPEG#PQVJGTRCTVVJCV+
RKEMGFWRQPCPFVJQWIJVYCUKPVGTGUVKPIYCUVJKUé4GXKGYGTEQORGPUCVKQPOC[
PQVDGDCUGFFKTGEVN[QTKPFKTGEVN[QPVJGXQNWOGQTPWODGTQHCFXGTUGFGVGTOKPC
VKQPUTGPFGTGFê+FQPçVRTGVGPFVJCVVJKUKUCEQORTGJGPUKXGTGXKGYQHVJKU0#+%
FTCHV6JGTGçUCNQVQHQVJGTUVWHHKPVJGTGDWVVJQUGUVTWEMOGCUVJGJKIJRQKPVU
(KPCNN[YJGTGCTGYGJGCFGF!+RWVUQOGPWODGTUVQIGVJGTHTQOCPQVJGT/4
TGUGCTEJTGRQTV
UGG6CDNG
6JKUKUQPG&CXG#ZGPGCPF&GPPKU*WNGVFKFQPVJGKORQTVCPEGQHJQOGECTG
VJQWIJKVKUCNKVVNGQWVQHFCVGCNTGCF[+VUJQYUVJGEWTTGPVWPOCPCIGFEQOOGTEKCN
RQRWNCVKQPCVFC[U+VFGHKPGUVJGEWTTGPVQRVKOCNUEGPCTKQCUFC[U+
YQWNFUC[PQYVJCVUJQWNFTGCFéTGEGPVRCUVêDGECWUGQWTEWTTGPVQRVKOCNFGHKPK
VKQPKUFC[U6JGUJQYKPIVJGTGKUWPFGTQWTNCVGUVOQFGNDWVQHOQUV
KPVGTGUVKUVJCVNQPIVGTOQRVKOCNUEGPCTKQQHFC[U1DXKQWUN[CNQVQHCFFKVKQPCN
VJKPIUJCXGVQJCRRGPDWVVGP[GCTUCIQ+FQPçVMPQYKH+YQWNFJCXGDGNKGXGF
FC[UYCURQUUKDNG;QWECPUGGVJCVQPVJGQXGTUKFGVJGTGFWEVKQPUCTGLWUVCU
FTCOCVKEKHPQVOQTGUQ
7VKNK\CVKQP4GXKGY+UUWGU
TABLE 3
PROJECTED INPATIENT HOSPITAL UTILIZATION
FOR VARIOUS SCENARIOS (DAYS PER 1,000 PER YEAR)
Scenario
Current Unmanaged
Current Optimal
Near-Term Optimal
Long-Term Optimal
Under-age-65
Population
450 days
180 days
140 days
60 days
Ages 65 and Over
Population
2,500 days
1,000 days
700 days
300 days
5QO[RTGFKEVKQPKUVJCVGXGT[JQURKVCNK\CVKQPYKNNGPFWRDGKPIKPVGPUKXGECTG+
OGPVKQPGFGCTNKGTCP*/1ENKGPVVJCVJCFQXGTKPVGPUKXGECTGPQYDWV+VJKPM
VJCVGXGPVWCNN[VJGCEWVGECTGJQURKVCNYKNNGUUGPVKCNN[LWUVDGYJCVVJG+%7UCTG
PQY6JGTGçNNDGUWDCEWVGHCEKNKVKGUVJCVçNNTGRNCEGVJGPQPKPVGPUKXGECTGJQURKVCN
K\CVKQPCPFVJGUGYKNNDGVJKPIUYGJCXGVQDWKNFKPVQQWTEQUVOQFGNUVJCVYG
TGCNN[JCXGPçVKPENWFGFCNQV[GV7NVKOCVGN[JQOGJGCNVJECTGYKNNCEEQWPVHQTCV
NGCUVQHJGCNVJECTGEQUVU+YCUVJKPMKPIVJCVEQWNFDGNQY+PUQOG/GFKECTG
OQFGNU+çXGUGGPKVçUVJGTGPQYDWVKVJCUIQVVGPVJCVJKIJD[UQOGCDWUGUQPVJG
JQOGECTGUKFG#U+UCKFYJGP[QWOCPCIGCYC[UQOGQHVJGCDWUGUKPJQOG
ECTG[QWIGVVJCVFQYPGXGPYJGP[QWUVCTVWUKPIKVVQTGRNCEGJQURKVCNK\CVKQP5Q
VJQUGCTGO[RTGFKEVKQPU
/T$TGPV.GG)TGGPYQQF9JCV+çOIQKPIVQFQKUWUGO[CEVWCTKCNET[UVCNDCNN
CPFMKPFQHUVGRKPVQVJGHWVWTGDWVRTQDCDN[PQVVQQHCTKPVQVJGHWVWTG+VYKNNDG
LWUVGPQWIJKPVJGHWVWTGVQIKXG[QWCNKVVNGKFGCQHYJCVOKIJVDGEQOKPIFQYPVJG
RCVJ
#UYGCNNMPQYJGCNVJECTGKUEJCPIKPISWKVGCDKVYKVJNQVUQHOGTIGTUQHVJGUG
FKHHGTGPVJGCNVJU[UVGOUCPFVJGKPVTQFWEVKQPQHECRKVCVKQP+VJKPMRTQXKFGTUCTG
DGEQOKPIOWEJOQTGKPVGTGUVGFKPVJGYJQNGOCPCIGOGPVQHECTG#UVJGUGJGCNVJ
U[UVGOUOGTIGVJG[JCXGOCP[OQTGTGUQWTEGUVJCVVJG[ECPCRRN[KPVJGEQPVKP
WWOQHECTG#VVJGUCOGVKOGVJG[CTGNQQMKPICVECRKVCVKQPVQDTKPIQPCFKHHGTGPV
V[RGQHHWPFKPICUYGNNCUFKHHGTGPVKPEGPVKXGU#UYGJCXGVCNMGFVQQWTJGCNVJECTG
ENKGPVUQXGTVJGRCUV[GCTQTUQKVUGGOUNKMGVJG[çTGVCMKPICOWEJOQTGEQORTG
JGPUKXGCRRTQCEJVQVJGECTGCPFWVKNK\CVKQPOCPCIGOGPVTCVJGTVJCPLWUVEQPEGP
VTCVKPIQPCHGYURGEKHKEKVGOU'UUGPVKCNN[YGçXGKFGPVKHKGFVJTGGEQORQPGPVUVQVJKU
EQORTGJGPUKXGECTGOCPCIGOGPVå+YKNNPQVUC[ECUGOCPCIGOGPV6JGOQTG
CRRTQRTKCVGVGTOJGTGKUECTGOCPCIGOGPV1PGKUFGCNKPIYKVJVJGFGOCPF
OCPCIGOGPVVJGUGEQPFKUWVKNK\CVKQPOCPCIGOGPVCPFVJGVJKTFKUFKUGCUG
OCPCIGOGPV
4'%14&8QNWOG
0QYCNNVJGUGEQORQPGPVUCTGPQVPGEGUUCTKN[PGY(QTGZCORNGFGOCPFOCPCIG
OGPVJCUDGGPWUGFVJTQWIJDGPGHKVFGUKIPRTKOCTKN[QTVJTQWIJRTGXGPVKXGUGTXKEGU
7VKNK\CVKQPOCPCIGOGPVKUYJCV<QGCPF$QDJCXGDGGPVCNMKPICDQWVåFGCNKPI
YKVJ[QWTRTGEGRVCPFCNNQH[QWTVTCFKVKQPCNWVKNK\CVKQPOCPCIGOGPV0QYYGçTG
NQQMKPICVVJGFKUGCUGOCPCIGOGPVEQORQPGPV6JGTGKUCPQVJGTUGUUKQPCVVJKU
OGGVKPIVJCVçNNDGFGCNKPIURGEKHKECNN[YKVJFKUGCUGOCPCIGOGPVYJKEJKULWUV
UVCTVKPICPFEQPEGPVTCVKPIQPCNKOKVGFPWODGTQHEQPFKVKQPUVJCVYGçTGNQQMKPICV
+VJKPMYJCVYGçTGOKUUKPICUYGIQVJTQWIJCNNQHVJKUKUVJCVVJGFGOCPFOCPCIG
OGPVEQORQPGPVCPFVJGFKUGCUGOCPCIGOGPVEQORQPGPVCTGXGT[YGCMYKVJKP
VJKUHQTOWNCCPFTGCNN[YJGTGCNNQHVJGEQPEGPVTCVKQPJCUDGGPKUQPVJGWVKNK\CVKQP
OCPCIGOGPVEQORQPGPV+VJKPMJQYGXGTVJCVYKVJVJGFGXGNQROGPVQHVJGUG
FKHHGTGPVJGCNVJU[UVGOUCPFVJGECRKVCVKQPCTTCPIGOGPVURTQXKFGTUCTGIQKPIVQDG
NQQMKPICVVJKPIUOWEJFKHHGTGPVN[VJCPVJG[JCXGKPVJGRCUV#NUQCUVJGKPHQTOC
VKQPU[UVGOUDGEQOGOWEJOQTGUQRJKUVKECVGFCPFCFFKVKQPCNOGFKECNTGUGCTEJKU
FQPGVJGOCPCIGFECTGQTICPK\CVKQPUCPFVJGJGCNVJU[UVGOUYKNNDGNQQMKPIVQ
GZRCPFVJGEQORQPGPVUQHFGOCPFOCPCIGOGPVCPFFKUGCUGOCPCIGOGPV
6JGTGCNEJCNNGPIGVJCVHCEGUVJGUGJGCNVJU[UVGOUCPFVJGOCPCIGFECTGQTICPK\C
VKQPUKURWNNKPIKVCNNVQIGVJGTCPFKVOWUVDGCEQQRGTCVKXGCTTCPIGOGPVDGVYGGP
DQVJVJGRTQXKFGTCPFOCPCIGOGPV
1PGECPPQVFQKVYKVJQWVVJGQVJGTCPFVJGMG[VQCNNQHVJKUKUQDXKQWUN[IQKPIVQ
DGVJGKPHQTOCVKQPCPFVJGVTCPUHGTQHKPHQTOCVKQPCPFV[KPIKVDCEMVQVJGOGCUWTG
OGPVQHQWVEQOGU9JCVYGçXGFQPGKUKFGPVKHKGFVJGUGFKHHGTGPVOCPCIGOGPV
RTQITCOUCPFVKGFVJGODCEMVQCRCVKGPV
%JCTV6JGJGCNVJ[RCVKGPVKUOQTGVKGF
VQVJGFGOCPFOCPCIGOGPVV[RGRTQITCOU;QWTRCVKGPVUVJCVCTGKPCEWVGECTG
ETKUKUCTGVJGQPGUVJCV[QWçTGFGCNKPIYKVJWUKPIWVKNK\CVKQPOCPCIGOGPV;QWCNUQ
JCXGVJGEJTQPKECNN[KNNRCVKGPVUVJCVOC[DGECPFKFCVGUHQTFKUGCUGOCPCIGOGPV
RTQITCOU6JGUGKPFKXKFWCNRCVKGPVUQDXKQWUN[YKNNDGIQKPIHTQODQZVQDQZDWV
YJCV[QWçTGVT[KPIVQFQYJGPCJGCNVJ[RCVKGPVEQOGUKPVQCPCEWVGECTGETKUKUKU
RTCEVKEGWVKNK\CVKQPOCPCIGOGPVHWPEVKQPUVJCVYKNNJQRGHWNN[DTKPIVJGRCVKGPVDCEM
KPVQVJGJGCNVJ[DQZNCVGTQP+VIQGUDCEMCPFHQTVJCPFKVçUVJGHNWKFF[PCOKEUVJCV
YKNNDGGXQNXKPICUYGIQVJTQWIJVJGFGXGNQROGPVQHVJGUGPGYCPFWREQOKPI
OCPCIGOGPVV[RGRTQITCOU
9JCV+çOIQKPIVQFQKUVQIQVJTQWIJGCEJQHVJGUGEQORQPGPVUKFGPVKH[HQT[QW
YJCVVJGQDLGEVKXGUCTGWPFGTGCEJQHVJGUGOCPCIGOGPVV[RGRTQITCOUCPFVJGP
CNUQVGNN[QWCNKVVNGDKVCDQWVRTQITCOUVJCVCTGCNTGCF[KPGZKUVGPEG$WVCU+UCKF
VJGTGCNEJCNNGPIGVJCVYGCNNHCEGKUDGKPICDNGVQRWNNCNNVJKUVQIGVJGT
7VKNK\CVKQP4GXKGY+UUWGU
CHART 2
PATIENT TYPES AT CERTAIN POINTS IN TIME
+çOIQKPIVQUVCTVYKVJVJGFGOCPFOCPCIGOGPVRTQITCOU#ICKPVJKUKUPQYQPG
QHVJGYGCMNKPMUKPVJGYJQNGRTQEGUUDWVYJCVYGçTGEQPEGPVTCVKPIQPKURTGXGP
VKQP/CP[QHVJGRTQITCOUVJCVCTGKPRNCEGCTGOQTGEQOOWPKV[DCUGFCPFVCTIGV
CNNKPUWTGFU#ICKPCUYGçTGFGCNKPIYKVJCECRKVCVKQPV[RGCTTCPIGOGPVVJKUKU
UQOGVJKPIPGY6JGRTQXKFGTUPQYJCXGVQEQPEGPVTCVGQPCRQRWNCVKQPQH
KPUWTGFUCPFPQVLWUVVJGRCVKGPVURTGUGPVKPIU[ORVQOU9JCVKUVJGQDLGEVKXGQH
FGOCPFOCPCIGOGPV!+VçUVQTGFWEGVJGCIITGICVGFGOCPFQHWPPGEGUUCT[ECTG
DWVKPQTFGTVQFQVJCVCJGCNVJRNCPQTJGCNVJU[UVGOTGCNN[JCUVQWPFGTUVCPFVJG
EWTTGPVJGCNVJUVCVWUQHVJCVRQRWNCVKQP%WTTGPVN[OCP[RNCPUQTKPUWTCPEGGPVKVKGU
FQPçVMPQYVJGEWTTGPVJGCNVJUVCVWUQHVJGKTRQRWNCVKQP*QYGXGT+VJKPMCNQVQH
VJCVKUEJCPIKPIVJTQWIJCNQVOQTGJGCNVJCUUGUUOGPVUVJCVCTGDGKPIGORNQ[GFD[
JGCNVJRNCPUIQKPIHQTYCTF5QVJG[çTGVT[KPIVQWPFGTUVCPFYJCVVJGEWTTGPVJGCNVJ
UVCVWUKUQHVJGKTRQRWNCVKQP9GCNUQYCPVVQKORTQXGVJGJGCNVJDGJCXKQTUQHVJGUG
KPFKXKFWCNU+VJKPMVJGTGJCXGDGGPCVVGORVUCVVJKUDWVHQTVJGOQUVRCTVVJG[
JCXGDGGPKPGHHGEVKXGLWUVDGECWUG[QWJCXGPçVDGGPCDNGTGCNN[VQTGCEJQWVVQVJCV
RQRWNCVKQPCPFIGVVJGOKPXQNXGFKPUQOGQHVJGUGRTQITCOU
#NUQ+YCPVVQUVTGUUVJGRTGXGPVKXGUGTXKEGUVJCVOQUVQHVJGOCPCIGFECTGQTICPK\C
VKQPUCTGFQKPIPQY9JCVçUOQTGKORQTVCPVKUVJG[CTGVT[KPIVQIGVVJCVRCVKGPV
CPFEQPUWOGTCPFOGODGTVQDGOQTGTGURQPUKDNGHQTVJGKTQYPUGNHECTG+CNYC[U
NKMGVQTGNCVGVJGKPUVCPEGQHOQXKPIFQYPVQ#VNCPVCVYQ[GCTUCIQ9GYGTG
RTGXKQWUN[KP/KPPGCRQNKU9GJCFCP*/16JCVYCUVJGYC[VJCVGXGT[DQF[
TGEGKXGFECTGCPFKVYCUITGCV+H[QWTEJKNFTGPIQVCNKVVNGUPKHHNG[QWVQQMVJGOKP
4'%14&8QNWOG
VQVJGFQEVQT6JGEQRC[OGPVYCUITGCV9GOQXGFFQYPVQ#VNCPVC9GçTGKP
CPCTGCVJCVFQGUPçVJCXGCP*/19GCTGPQYUWDLGEVVQCFGFWEVKDNG
9GNNKVçUCOC\KPIJQYCNNQHCUWFFGPO[YKHGHQWPFQWVJQYGZRGPUKXGJGCNVJ
ECTGKUPQYVJCVYGIGVDKNNUVJCVCTGUWDLGEVVQVJCVFGFWEVKDNG5QPQYYGIQ
D[VJGTWNGQHVJTGGFKCTTJGCCEQWIJQTCVGORGTCVWTGåVJG[JCXGVQJCXGVYQ
QWVQHVJGVJTGGDGHQTGYGVCMGVJGOVQCFQEVQT;QWMKPFQHIGVKPVQ[QWTUGNHECTG
V[RGQHVJKPI*QYOCP[QH[QWTRCTGPVUYGTGVTGCVKPI[QWYJGP[QWYGTGMKFU!
6JGQVJGTKORQTVCPVRQKPVKPFGOCPFOCPCIGOGPVKUVJCVOCP[OGODGTUTGCNN[
FQPçVMPQYJQYVQCEEGUUVJGU[UVGOQTVJG[OC[MPQYJQYVQCEEGUUVJGU[UVGO
DWVKPCPKPCRRTQRTKCVGYC[#U$QDYCUUC[KPIQPVJG/GFKECKFUKFGOQUVQHVJG
RGQRNGKP/GFKECKFOKIJVCEEGUUKVVJTQWIJVJGGOGTIGPE[TQQO9GNNYGPGGFVQ
WPFGTUVCPFOQTGCDQWVJQYYGOKIJVCFFTGUUVJKURQKPVCPFVJCVçUYJ[OCP[CTG
IQKPIVQCICVGMGGRGTV[RGRTQITCO9GçTGJQRKPIVJCVRTKOCT[ECTGRJ[UKEKCPYKNN
DGCECVCN[UVVQUVGGTRCVGPVUKPVQVJGTKIJVCTGCU
6JGTGCTGUGXGTCNRTCEVKEGUEWTTGPVN[KPRNCEGWPFGTFGOCPFOCPCIGOGPVRTQITCOU
1PGKURCVKGPVGFWECVKQPCPFEQOOWPKECVKQPåPQVUQOWEJLWUVPGYUNGVVGTUCU
[QWçXGRTQDCDN[JGCTFCDQWVDWVXKFGQUCPFUGNHECTGDQQMU+HUQOGQPGKU
FKCIPQUGFYKVJCRCTVKEWNCTFKUGCUGQTJCUCRCTVKEWNCTECUGJGQTUJGOC[IGVC
XKFGQQPHQTGZCORNGVJGCFXCPVCIGUCPFFKUCFXCPVCIGUQHEJGOQVJGTCR[QXGT
JCXKPIUWTIGT[2GQRNGCTGUKVVKPIFQYPCPFNQQMKPICVVJGUGXKFGQUCPFVT[KPIVQ
OCMGVJGKTQYPFGEKUKQPUQPYJKEJYC[VJG[YCPVVQIQ6JGTGCTGCNUQUGXGTCN
RTGXGPVKQPCPFYGNNPGUURTQITCOUQWVVJGTGYKVJYQTMUJQRUFGCNKPIYKVJJ[RGTVGP
UKQPCPFUOQMKPI/CP[JGCNVJCFXKEGPWTUGNKPGUJCXGDGGPKPVTQFWEGFYJGTG
KPFKXKFWCNUECPECNNWRCPFIGVKPHQTOCVKQPCDQWVXCTKQWUFKUGCUGUQTJQYVJG[
OKIJVDGCDNGVQCEEGUUVJGU[UVGO6JGTGKUCNUQVGNGRJQPGDCUGFVTKCIG7UWCNN[
YJGPKVçUCHVGTJQWTU[QWVT[VQHKIWTGQWVYJGTG[QWEQWNFIQQTIGVCFXKEGQP
VTGCVOGPVCPFKHVJGTGçUCEGTVCKPWTIGPVECTGV[RGQHHCEKNKV[+VJKPMQPGQHVJG
KORQTVCPVVJKPIUGURGEKCNN[CUKVTGNCVGUVQ/GFKECTGCPF/GFKECKFKUFTWIEQORNK
CPEG6JKUKUYJGTG[QWVT[VQIGVKPHQTOCVKQPQPVJGFTWIUVJCVVJQUGKPFKXKFWCNU
CTGVCMKPIVQUGGYJGVJGTVJQUGFTWIUCTGEQPHNKEVKPIYKVJQPGCPQVJGTQTRQUUKDN[KH
VJGTGCTGQVJGTCNVGTPCVKXGFTWIUVJCVOKIJVTGRNCEGVJGKTECFTGQHTGFDNWG[GNNQY
CPFRKPMRKNNU
(KPCNN[YGTGIGVVKPIKPVQOGODGTPGGFUCUUGUUOGPV+VJKPMVJKUKUYJGTGYGçTG
UGGKPIOWEJOQTGCFXCPEGOGPV+VOC[PQVDGCHQTOCNOGODGTPGGFUCUUGUUOGPV
DWVKVOC[DGCUKVWCVKQPYJGTGVJGRTQXKFGTUKVUFQYPYKVJVJCVRCVKGPVCPFIQGU
QXGTSWGUVKQPUCPFCPUYGTUTGNCVKPIVQOGODGTPGGFUCPFIGVUCIQQFCUUGUUOGPVQH
OGODGTHWPEVKQPCNKV[CUYGNNCUOGFKECNRTQDNGOU
7VKNK\CVKQP4GXKGY+UUWGU
5QOGVJKPIVJCVTGCNN[PGGFUVQDGCFFTGUUGFRTQDCDN[GXGPHCTVJGTKPVJGHWVWTGKU
FGCNKPIYKVJVJGKUUWGQHVJGNKXKPIYKNNUCPFEJTQPKEKNNPGUUGU6JCVKUUQOGVJKPI
VJCVYKNNEQOGKPVQRNC[CUYGNNCUJGCNVJRNCPUIGVOQTGKPXQNXGFYKVJVJKUFGOCPF
UKFGQHVJKPIU6JG[YKNNJGNRKPFKXKFWCNUFGXGNQRVJGKTNKXKPIYKNNUVQUGGKHVJG[CTG
CDNGCPFYKNNKPIVQRWVUQOGVJKPINKMGVJCVKPVQRNCEG+çXGJCFCRGTUQPCNGZRGTK
GPEGYKVJO[QYPOQVJGTYJQYGPVVJTQWIJCVTCPURNCPVCPFKHKVYCUPçVHQTVJG
NKXKPIYKNNVJCVUJGJCFVJQUGFQEVQTUYQWNFJCXGMGRVJGTCNKXGHQTCPQVJGTVYQ
OQPVJUKPCXGT[XGIGVCVKXGUVCVG6JCVYCUXGT[VTQWDNKPIHTQOVJGUVCPFRQKPVVJCV
VJGHCOKN[JCFCNTGCF[OCFGVJGFGEKUKQPDWVVJGFQEVQTUVKNNUCKFKHKVYCUPçVHQTVJG
NKXKPIYKNNVJGECTGRTQXKFGTUEQWNFPçVEQORN[YKVJVJGHCOKN[çUYKUJGU5Q+VJKPM
VJKUKUCPQVJGTVJKPIVJCVJCUVQEQOGKPVQVJGFGOCPFOCPCIGOGPVEQORQPGPV
$WVKPQTFGTHQTCNNQHVJKUVQYQTMQPVJGFGOCPFUKFG[QWFGHKPKVGN[PGGFVJGDW[
KPD[VJGRTQXKFGTUDGECWUGVJGRTQXKFGTUTGCNN[OWUVGPEQWTCIGVJGRCVKGPV
FGEKUKQPOCMKPIRTQEGUUCUYGNNCUCEEGRVCPEGQHTGURQPUKDKNKV[HQTUGNHECTG6JCVçU
IQKPIVQDGCDKIUVGRDWVKVKUCUVGRVJCVJGCNVJU[UVGOUCPFOGFKECNITQWRUCTG
UVCTVKPIVQVTCPUKVKQPVQ
7PFGTECRKVCVKQPCUYGIQVQVJGUGRTQITCOU[QWFQPGGFVJGJGNRQHVJCVOGO
DGT;QWECPçVFQKVD[[QWTUGNH+H[QWJCXGVJGOGODGTEQOKPIKPHQTGXGT[NKVVNG
VJKPIVJCVVJG[PGGFVTGCVOGPVQPVJCVçUIQKPIVQDGUWKEKFCNHQTOCP[QHVJG
RTQXKFGTU6JG[FQPGGFVJGCUUKUVCPEGQHVJGOGODGTCPFVQJCXGVJGOGODGT
VCMGUQOGTGURQPUKDKNKV[
6JGUGEQPFDQZQH%JCTVFGCNUYKVJVJQUGRCVKGPVUYJQCTGKPCPCEWVGECTGETKUKU
6JKURGTVCKPUOQTGVQGRKUQFKEECTG7UWCNN[VJGWVKNK\CVKQPOCPCIGOGPVKUJQURKVCN
DCUGFGXGPVJQWIJYGçTGOQXKPIVQCODWNCVQT[ECTGVCTIGVKPIVJGCFOKUUKQPUCPF
VJGPIGVVKPIKPVQECTGRCVJYC[U6JKUKUXGT[UKOKNCTVQVJGVJKPIUVJCVYGTGVCNMGF
CDQWVGCTNKGTD[<QGCPF$QD6JGQDLGEVKXGUQHVJGUGCTGVQFKTGEVVJGECTGVQVJG
OQUVCRRTQRTKCVGUGVVKPIVJCVYGECP+VJKPMVJGOCPCIGFECTGQTICPK\CVKQPUCPF
VJGUGOGTIGFJGCNVJU[UVGOUTGCNN[JCXGCDGVVGTQRRQTVWPKV[VQFQVJCVVJCP[QWT
OQTGHGGHQTUGTXKEGV[RGGPXKTQPOGPVUQTGXGP[QWTNCTIGTKPFKXKFWCNRTCEVKEG
CUUQEKCVKQP
+2#V[RGPGVYQTMUVJCVCTGEQPVTCEVKPIYKVJOWNVKRNGRTQXKFGTUQWVKP
VJGEQOOWPKV[+VCNUQJGNRUOCPCIGVJGOGFKECNCRRTQRTKCVGPGUU+UVJGVTGCVOGPV
CRRTQRTKCVG!+UVJGVGEJPQNQI[[QWçTGWUKPICRRTQRTKCVG!9JCVCDQWVVJGRNCEGQH
UGTXKEG!9JCVYGçTGVT[KPIVQFQKUTGVWTPVJCVRCVKGPVVQJKUQTJGTQRVKOCNHWPE
VKQPCNUVCVWUIGVJKOQTJGTDCEMKPVQVJCVJGCNVJ[RCVKGPVDQZUQ[QWECPCICKPDG
YQTMKPIYKVJJKOQTJGTQPVJQUGRTGXGPVKXGV[RGUGTXKEGU
9GçXGTGXKGYGFUQOGQHVJGRTQITCOUCNTGCF[6JGRTGCFOKUUKQPTGXKGYEQPEWT
TGPVKPRCVKGPVTGXKGYFKUEJCTIGRNCPPKPICPFOGFKECNPGEGUUKV[TGXKGYCTGCNN
UQOGYJCVVTCFKVKQPCNV[RGUQHWVKNK\CVKQPOCPCIGOGPVRTQITCOU6JKPIUVJCV[QWçNN
4'%14&8QNWOG
DGUGGKPIEQOKPIKPVQRTCEVKEGGXGPOQTGCTGVJGENKPKECNECTGRCVJYC[UVJCVIGV
KPVQRTCEVKEGIWKFGNKPGUCPFRTQVQEQNU6JGVJKPIVJCVYCUUQOGYJCVCOC\KPIYJGP
+YCUTGUGCTEJKPIUQOGQHVJKUYCUVJCVKPVJGTGYGTGHQTOCNIWKFGNKPGU+
IWGUU[QWçFUC[VJCVYGTGRTKPVGF0QYVJGTGCTGCDQWVRTQVQEQNU
IWKFGNKPGUGUVCDNKUJGFVJCVCTGTGEQIPK\GFD[PCVKQPCNHKTOUQTFGXGNQRGFD[
PCVKQPCNHKTOU6JGTGCTGVJQWUCPFUQHQVJGTUVJCVJCXGDGGPJQOGITQYPD[
KPFKXKFWCNJGCNVJU[UVGOUQTURGEKCNVKGUDGECWUGVJG[FKFPçVNKMGVJGOQTGHQTOCN
IWKFGNKPGU4KIJVPQYVJGTGçUTGCNN[PQWPKHQTOYC[QHWUKPIIWKFGNKPGU6JG
JGCNVJU[UVGOUCTGRKEMKPICPFEJQQUKPIVJQUGVJCVDGUVUWKVVJGKTPGGFU
6GEJPQNQI[CUUGUUOGPVKUCPQVJGTVJKPIVJCVTGCNN[YKNNDGKORQTVCPVCUYGIQ
HQTYCTFCUHCTCUVJGEQUVDGPGHKVTGNCVKQPUJKRQHJQYVGEJPQNQI[KUWUGFCPFYJGP
KVçUWUGF9JCVJQRGHWNN[KUFGXGNQRKPIHTQOIQKPIVJTQWIJCNNQHVJKUKUVJCVVJG
OGFKECNRQNKEKGUCPFRTQEGFWTGUQHOCP[JGCNVJRNCPUCPFQTICPK\CVKQPUCTG
GXQNXKPICUYGIQHQTYCTFVQDGOQTGENKPKECNN[DCUGF
6JGNCUVDQZKP%JCTVFGCNUYKVJVJGEJTQPKECNN[KNNRCVKGPVCPFJGTGVJGSWGUVKQP
KUJQYECPYGIGVVJGUGKPFKXKFWCNUKPVQCOCPCIGOGPVRTQITCOVJCVYKNNTGCNN[DG
QRVKOCNHQTVJGFKUGCUGQTVJGRQVGPVKCNJKIJTKUMVJCVVJG[çTGTWPPKPICUVJG[IQ
HQTYCTF!9JCVYGçTGVT[KPIVQFQKUFGXGNQRCFKUGCUGOCPCIGOGPVRTQITCOVJCV
IQGUCETQUUVJGYJQNGECTGEQPVKPWWO9GYCPVVQKFGPVKH[VJQUGRGQRNGVJTQWIJC
JGCNVJCUUGUUOGPVYJQCTGVJGJKIJTKUMKPFKXKFWCNUHQTEGTVCKPEJTQPKEKNNPGUUGU+H
YGECPKFGPVKH[VJGOWRHTQPVVJGPYGECPOCMGUWTGVJCVVJG[YKNNDGTGEGKXKPIVJG
PGEGUUCT[VTGCVOGPVCUVJG[IQHQTYCTFCPFVJGGFWECVKQPVJCVVJG[çNNPGGFKPQTFGT
VQTGCNN[OCPCIGVJCVFKUGCUGCUKVGXQNXGUVJTQWIJVJGKTNKHGVKOG9GçTGIQKPIVQ
VCTIGVVJQUGJKIJTKUMKPFKXKFWCNUCPFVJGPKHYGFQIGVVJQUGKPFKXKFWCNUNCVGTQPKP
VJGRTQEGUUKVçUUVKNNCDGVVGTYC[QHOCPCIKPIVJQUGJKIJEQUVECUGUTCVJGTVJCPLWUV
CVTCFKVKQPCNPGIQVKCVKQPQHHGGU9GYKNNJCXGCOQTGUVTWEVWTGFFKUGCUGOCPCIG
OGPVYKVJRTQVQEQNUCPFIWKFGNKPGUQPJQYVQVTGCVVJQUGKPFKXKFWCNU
1PGQHVJGQDLGEVKXGUVJCVYGYKNNPGGFVQKFGPVKH[HQTVJGEJTQPKEFKUGCUGOCPCIG
OGPVRTQITCOUKUVQVCTIGVVJQUGJKIJTKUMKPFKXKFWCNUWRHTQPVVJTQWIJVJGJGCNVJ
CUUGUUOGPVRTQEGUU4KIJVPQYKP%CNKHQTPKCHQTGZCORNGVJGTGCTGOCP[ENKPKEU
KPXKVKPIVJQUGKPFKXKFWCNUYJQJCXGEQOGVQVJGKTRTQITCOQPCECRKVCVGFDCUKUVQ
EQOGKPHQTCHTGGJGCNVJCUUGUUOGPV6JG[YKNNIQVJTQWIJCPFKFGPVKH[YJQVJQUG
JKIJTKUMKPFKXKFWCNUCTGVQOCMGUWTGVJCVVJG[çTGIQKPIVQIGVVJGOQUVCRRTQRTKCVG
CPFGHHGEVKXGECTGIQKPIKPVQVJGHWVWTG
9GCNUQPGGFVQGPUWTGCEEGUUVQVJGOQUVCRRTQRTKCVGRTQXKFGT+çOPQVCNYC[U
EQPXKPEGFVJCVVJGICVGMGGRGTKUVJGDGUVGPVT[KPVQVJGU[UVGO1PEGVJCVRGTUQPKU
KFGPVKHKGFCUJCXKPICJKIJTKUMRQVGPVKCNHQTCFKUGCUGQTRGTJCRUVJG[JCXGC
EJTQPKEKNNPGUUFKUGCUGCRTKOCT[ECTGRJ[UKEKCPOC[PQVDGVJGDGUVRGTUQPHQT
7VKNK\CVKQP4GXKGY+UUWGU
VJGOVQUGGQPCTGIWNCTDCUKUVQVTGCVVJCVFKUGCUG6JG[OKIJVPGGFCURGEKCNKUVUQ
YGTGCNN[YCPVVQGPUWTGCEEGUUVQVJGOQUVCRRTQRTKCVGRTQXKFGTKPNKIJVQHYJCV
VTGCVOGPVKUPGGFGF
$GKPIOQTGHQEWUGFQPFKUGCUGOCPCIGOGPVKUIQKPIVQDGCEJCNNGPIGDGECWUG
[QWçTGIQKPIVQPGGFVQEQNNGEVKPHQTOCVKQPFKHHGTGPVN[VJCP[QWJCXGFQPGDGHQTG
DCUGFQPURGEKHKEKPHQTOCVKQPVTGCVOGPVTGUQWTEGUDGKPIWUGFVJGWVKNK\CVKQPCPF
EQUVFGCNKPIYKVJVJQUGURGEKHKEFKUGCUGU+VDGEQOGUEQORNKECVGFDGECWUGPQY
[QWçTGEQNNGEVKPIKPHQTOCVKQPYJGPVJGRGTUQPKUCEVWCNN[JGCNVJ[CPF[QWTG
NQQMKPICVYJCVVJGUKIPUCTGIQKPIHQTYCTFVQYJGPJGQTUJGCEVWCNN[EQPVTCEVUCP
KNNPGUU#UKPFKECVGFDGHQTGYGJCXGVQOCPCIGVJGJGCNVJECTGCETQUUVJGYJQNG
EQPVKPWWOQHECTGåYJGPKPUWTGFUCTGJGCNVJ[KPVJGKTCEWVGUVCIGUCPFCNUQYJGP
VJG[DGEQOGEJTQPKECNN[KNN
*GTGKUCNKUVQHFKUGCUGOCPCIGOGPVRTQITCOUEWTTGPVN[QWVVJGTG
&KCDGVGU
%JTQPKE.WPI
%JTQPKE%QPIGUVKXG*GCTV(CKNWTG
%CTFKCE4GJCD
%JTQPKE*[RGTVGPUKQP
%JTQPKE2J[UKECN6JGTCR[4GJCD
4GPCN&KUGCUG
#UVJOC
#+&5
+FQPçVVJKPMYGPGGFVQIQQXGTVJGODWVCU[QWECPVGNNVJG[JCXGDGGPURGEKHKE
HQTEGTVCKPFKUGCUGU6JGTGECPDGSWKVGCDKVQHUCXKPIUHTQOUQOGQHVJGUGCUCRNCP
IQGUHQTYCTF
+çFNKMGVQIQQXGTYJCV+HGGNCTGUQOGQHVJGMG[UVQCUWEEGUUHWNRTQITCOCUYGVT[
VQRWNNVJKUYJQNGVJKPIVQIGVJGT(KTUV[QWPGGFVJGEQOOKVOGPVHTQODQVJ[QWT
RTQXKFGTUCPFOCPCIGTUVQFGXGNQRUWEJCRTQITCO+H[QWFQPçVJCXGVJGDW[KP
HTQOVJGRTQXKFGTUKVYQPçVYQTMCPFVJCVçUVJGHGGFDCEMVJCVYGçXGIQVVGPHTQOCNN
QHVJQUGYJQJCXGDGGPNQQMKPICVVJGFGOCPFOCPCIGOGPVKFGC+HVJG[FQPçV
JCXGVJCVDW[KPKVYKNNDGKORQUUKDNGVQOCMGKVYQTMCPFVJCVçUYJ[[QWHKPFVJCV
OCP[QHVJGUVCHHOQFGNRNCPUCPFVJGOGFKECNITQWRV[RGRTQITCOUCTGVJGQPGU
VJCVCTGIGVVKPIKPVQVJKUOQTGVJCPVJG+2#U+VçUXGT[FKHHKEWNVHQTVJG+2#YJKEJ
EQPVTCEVUKPFGRGPFGPVN[VQTGCNN[IGVVJGDW[KPHQTOQUVQHVJGUGRTQITCOU;QW
CNUQPGGFVJGDW[KPHTQOVJGOCPCIGTUDGECWUGCU[QWECPKOCIKPGKVDGEQOGU
XGT[NCDQTKPVGPUKXGVQOGCUWTGVJGTGUWNVUCPFOCKPVCKPRQUKVKXGRTQXKFGTTGNCVKQPU
4'%14&8QNWOG
6JKUKUCFKHHGTGPVYC[HQTVJGRTQXKFGTVQTGNCVGVQVJGRCVKGPV6JGTGKUCNQVQH
GFWECVKQPVJCVYKNNDGPGGFGFQPVJGRTQXKFGTUKFG6JGRJ[UKEKCPUYKNNPGGFVQ
GPEQWTCIGVJGRCVKGPVUVQFQUQOGUGNHECTG'FWECVKPIRCVKGPVUVQNQQMCVVJG
FKHHGTGPVCNVGTPCVKXGUVJCVCTGCXCKNCDNGVQVJGOVQJGNRFGEKFGYJKEJEQWTUGQH
CEVKQPVJG[YCPVVQVCMGKUCNUQKORQTVCPV#UOGODGTUHGGNOQTGKPEQPVTQNVJG[
WUWCNN[HGGNOQTGGORQYGTGFCPFOQTGUCVKUHKGF9GçXGJGCTFVJCVOGPVKQPGFKP
HQEWUITQWRUGUUKQPU#UVJGUGKPFKXKFWCNUWPFGTUVCPFOQTGQHYJCVçUJCRRGPKPIVQ
VJGOCPFWPFGTUVCPFVJGKTDQFKGUVJG[YKNNDGEQOGOQTGEQOHQTVCDNGYKVJUGNH
ECTG;QWHQNMUMPQY[QWTDQF[;QWWPFGTUVCPFYJGP[QWCEJGCPFYJGTG[QW
CEJGUQQPCPFUQHQTVJDWVKH[QWWPFGTUVCPFOQTGQHYJCVçUJCRRGPKPIVQ[QW
CPFYJCV[QWTQRVKQPUCTG[QWHGGNOQTGGORQYGTGFOQTGWPFGTEQPVTQNCPF
[QWçTGNKMGN[VQDGOQTGUCVKUHKGFYKVJVJGVTGCVOGPVVJCV[QWçTGTGEGKXKPITCVJGTVJCP
KH[QWLWUVNGCXGKVWRGPVKTGN[VQVJGFQEVQT
#MG[VQKVQPEGCICKPYKNNDGVJGVKOGN[KPHQTOCVKQPIQKPIVQDQVJVJGRCVKGPVCPF
VJGRTQXKFGT+VJKPMKVçNNDGXGT[KORQTVCPVHQTVJGUGRTQITCOUVQDGENGCTN[FGHKPGF
CPFVQMPQYYJQçUIQKPIVQDGTGURQPUKDNGHQTYJCV9JCVCTGVJGRTQXKFGTçU
TGURQPUKDKNKVKGUIQKPIVQDGKPTGNCVKQPVQVJGOCPCIGTçUCPFVJGEQPUWOGTçUTGURQP
UKDKNKVKGU!
9GçTGVT[KPIVQIGVGCTN[KFGPVKHKECVKQPQHJKIJTKUMKPFKXKFWCNUGURGEKCNN[VJQUGYKVJ
JKIJTKUMHQTRTGXGPVCDNGKNNPGUUGU;QWECPVJGPIGVVJGOKPVQRTGXGPVKXGRTQITCOU
KPQTFGTVQRTGXGPVCRQVGPVKCNKNNPGUUIQKPIHQTYCTF1T[QWOKIJVHKPFQWVVJCV
RGTUQPFQGUJCXGCEWTTGPVKNNPGUUHQTYJKEJVJG[çTGWPFGTUGTXGF+HVJCVçUVJGECUG
OCP[VKOGURGQRNGJCXGDGGPGPEQWTCIGFVQIQVQVJGRJ[UKEKCPTKIJVCYC[TCVJGT
VJCPNGVVJCVEQPFKVKQPIQHQTCNQPIRGTKQFQHVKOG+VJKPMQPGQHVJGOQUVKORQT
VCPVVJKPIUHTQOCOCPCIGTKCNUVCPFRQKPVKUEQOKPIWRYKVJCEQOOWPKECVKQP
UVTCVGI[VJCVYKNNQHHUGVVJGNKMGN[ETKVKEUVJCVYKNNEQOGWRCUVJKURTQITCOGXQNXGU
;QWTETKVKEUYKNNXKGYVJKUCUTGUVTKEVKPICEEGUU;QWçTGUWDUVKVWVKPIECTGNGVVKPIVJG
GPTQNNGFJCXGOQTGKPRWVCPFVJKUYKNNDGEQPUKFGTGFRQQTSWCNKV[5Q+VJKPMKVçNN
DGETKVKECNVQRWVVQIGVJGTCEQOOWPKECVKQPUVTCVGI[+H[QWFQPQV[QWOKIJVDGQP
VJGQçENQEMPGYUGXGT[QVJGTYGGMCUYGHKPFOQUV*/1UCTG
1PGQHVJGCPVKEKRCVGFTGUWNVUKUVJCVYGGZRGEVCTGFWEVKQPKPWPPGEGUUCT[CEWVG
ECTG6JGTGçNNDGOQTGGHHKEKGPVWUGQHTGUQWTEGUDGECWUGJGCNVJU[UVGOUCPF
OCPCIGFECTGQTICPK\CVKQPUYKNNIWKFGKPFKXKFWCNUVQCRRTQRTKCVGTGUQWTEGUDCUGF
QPVJGEQPVKPWWOQHECTG$[IKXKPIVJGOGODGTUVJGRQYGTCPFCNUQVJGMPQYN
GFIGVJG[çNNRTQDCDN[JCXGOQTGOGODGTUCVKUHCEVKQP;QWçNNTGCNN[ETGCVGC
UVTQPIGTTGNCVKQPUJKRDGVYGGPVJGRCVKGPVCPFVJGFQEVQTDGECWUGVJG[YKNNJCXG
QRGPFKUEWUUKQPUCPFVJG[YKNNDGFKUEWUUKPIVJGECTGVJCVçUDGKPIRTQXKFGFTCVJGT
VJCPVJGRCVKGPVLWUVTGEGKXKPIKVCUKUCPFOWEJTCOOGFFQYPJKUQTJGTVJTQCV
*QRGHWNN[YJCVYGYKNNCEEQORNKUJKUKORTQXGFHWPEVKQPCNUVCVWUQHVJGRCVKGPVD[
7VKNK\CVKQP4GXKGY+UUWGU
HKTUVKFGPVKH[KPIGCTN[RQVGPVKCNKNNPGUUGUCPFGCTN[JKIJTKUMKPFKXKFWCNUCPFVJGPD[
DGKPIOQTGFKUGCUGHQEWUGFTCVJGTVJCPLWUVWVKNK\CVKQPHQEWUGF
6JGTGCTGNKOKVGFTGUWNVUFCVCQPCNNVJTGGQHVJGUGFKHHGTGPVEQORQPGPVU#ICKPVJG[
CTGKPFKXKFWCNRTQITCOUCPFPQQPGJCUTGCNN[RWNNGFVJGOVQIGVJGT+H+JCFVQ
KFGPVKH[YJQCTGVT[KPIVQRWNNVJGUGVQIGVJGT+YQWNFUC[-CKUGTDGECWUGKVJCU
RTQXKFGFTGUWNVUKPCNNVJTGGFKHHGTGPVCTGCU;QWTQVJGTUVCHHOQFGNUFGCNKPIYKVJ
ITQWRJGCNVJå2WIGV5QWPF*CTXCTF2KNITKOCPF75*GCNVJ%CTGåCTGVJGRNCPU
VJCV+MPQYQHVQFCVG5QOGOGFKECNITQWRUYKVJKP%CNKHQTPKCCTGUVCTVKPIVQRWNN
VJGUGV[RGQHRTQITCOUVQIGVJGTCPFCTGVTGCVKPIWVKNK\CVKQPOCPCIGOGPVCUC
EQORTGJGPUKXGECTGV[RGRTQITCOTCVJGTVJCPLWUVEQPEGPVTCVKPIQPVJGWVKNK\CVKQP
UKFG9GçTGLWUVIKXKPI[QWUQOGGZCORNGUQHYJGTGVJGTGJCUDGGPUQOGUCXKPIU
DCUGFQPUVWFKGU1PGUVWF[QDUGTXGFCFTQRKPVQVCNEQOOGTEKCNXKUKVU+PC
/GFKECTGTKUMEQPVTCEVVJGTGYCUCFTQRCPFHQTCPQVJGTRNCPVJGTGYCUC
FTQRLWUVKPVJGHKTUV[GCTQHKORNGOGPVKPIFKHHGTGPVFGOCPFOCPCIGOGPVRTQITCOU
+ORCEVUQHKOOWPK\CVKQPUCPFRTGXGPVKXGECTGHQTVJGGNFGTN[JCXGCNUQDGGP
FQEWOGPVGF
6JKUKUOQUVGHHGEVKXGKP/GFKECTGTKUMCPFOCPCIGF/GFKECKFRTQFWEVCTGCU
$GECWUGVJG[JCXGVJGITGCVGUVPWODGTQHRGQRNGYKVJEJTQPKEFKUGCUGUCPFTGCNN[
VJGITGCVGUVQRRQTVWPKV[VQFGCNYKVJVJQUGRQRWNCVKQPUVJGUGRTQFWEVUYKNNDGPGHKV
OQUVHTQOCEQORTGJGPUKXGOCPCIGOGPVRTQITCONKMGVJKU%CRKVCVGFJGCNVJ
U[UVGOUYKNNCNUQDGPGHKVDGECWUGVJG[ECPCNNQECVGVJGFKHHGTGPVTGUQWTEGUCUYGNNCU
KPHNWGPEGRTQXKFGTDGJCXKQTOWEJOQTGVJCPRGTJCRU+2#U6JG[çTGVT[KPIVQNQQM
CVVJGRQRWNCVKQPQTVT[KPIVQNQQMCVVJGKTOGODGTUJKRCUCRQRWNCVKQPCPFVTGCVKPI
KVCUUWEJTCVJGTVJCPNQQMKPICVKVQPCRCVKGPVDCUKU
+VJCUDGGPO[QDUGTXCVKQPCU+çXGIQPGVJTQWIJUGXGTCNJGCNVJTGHQTORTQRQUCNU
CPFRTQLGEVUYKVJVJGHGFGTCNIQXGTPOGPVUVCVGCPFUQHQTVJVJCVGXGT[DQF[KU
FGCNKPIOQTGYKVJVJGUWRRN[UKFG6JCVKUVJGYTQPIOGUUCIGVJCVVJGRQNKVKEKCPU
CTGIKXKPITKIJVPQYDWVVJCVçUDGECWUGVJG[çTGRQNKVKEKCPU;QWECPIGVOQTGHQT
NGUURTKEG+VJKPMWPVKNYGCEEGRVVJGTGURQPUKDKNKV[CPFTGCNN[CEMPQYNGFIGVJCVYG
JCXGVQJKVVJGFGOCPFUKFGCVUQOGRQKPV+FQPçVTGCNN[HGGNCP[JGCNVJTGHQTO
RCEMCIGKUIQKPIVQDGUWEEGUUHWN6JCVçUYJGTG+VJKPMVJKUV[RGQHRTQITCOECP
UWEEGGF6JGRTQXKFGTUVJGOUGNXGUWPFGTUVCPFVJGFGOCPFOCPCIGOGPVEQORQ
PGPVCPFCTGEQPEGTPGFYKVJKVCPFVJG[çTGVJGQPGUVJCVYKNNNKMGN[UVCTVUVTWEVWTKPI
VJKUV[RGQHEQORTGJGPUKXGECTGOCPCIGOGPVVQKPEQTRQTCVGPQVQPN[WVKNK\CVKQP
OCPCIGOGPVDWVVJGFGOCPFOCPCIGOGPVWRHTQPVCUYGNNCUVJGFKUGCUGOCPCIG
OGPV
4'%14&8QNWOG
/T&QDUQP+CITGGYKVJVJGNCUVRQKPV[QWOCFGCDQWVVJGIQXGTPOGPVRTQITCOU
PGGFKPIVQTGEQIPK\GVJGFGOCPFUKFG;QWYQPçVIGVCP[EQPVTQXGTU[HTQOOGQP
VJCVQPG
/T5COWGN$8GPCDNG/CP[QH[QWTUNKFGUJCFVQFQYKVJSWGUVKQPPCKTGUVQ
KFGPVKH[VJGCVTKUMQTNGUUJGCNVJ[KPFKXKFWCNU+VUGGOUVQOGVJCVVJGTGçUCRGTEGR
VKQPCOQPIVJGRQVGPVKCNRCVKGPVUJGTGVJCVVJKUUQTVQHSWGUVKQPPCKTGEQWNFDGWUGF
VQECTXGVJGOQWVQHCRNCP9GCNTGCF[UGGUC[UVQRNQUUXGPFQTUYCPVKPIVQ
UGITGICVGKPFKXKFWCNUQWVQHUVQRNQUUCTTCPIGOGPVU*QYYKNNVJKURGTEGKXGFTKUMDG
CFFTGUUGF!+UKVUQOGVJKPIVJCVEQWNFDGJCPFNGFKPVGTPCNN[YKVJKPQWTQYPRNCPUQT
KUVJGTGUQOGGZVGTPCNKPHNWGPEGVJCVJCUEQOGKPVQRNC[!
/T)TGGPYQQF6JGMG[VQVJGRTQITCOUVJCVYGçXGUGGPFGCNKPIYKVJVJGJGCNVJ
CUUGUUOGPVUKUJQY[QWEQOOWPKECVGVJGO9GFQPçVUGGVJGUKVWCVKQPYJGTGKP
QTFGTVQUKIPWRHQTQWTRTQITCO[QWJCXGVQHKNNQWVCJGCNVJCUUGUUOGPV+VJCUVQ
FQYKVJDGKPIWRHTQPV6JGRTQXKFGTUJCXGDQWIJVKPVQVJGKFGCVJCVVJG[PGGFVQ
WPFGTUVCPFYJCVVJGJGCNVJTKUMQHCRQRWNCVKQPKU(QTGZCORNGUQOGQHVJG
OGFKECNITQWRUCEVWCNN[KPXKVGKPFKXKFWCNUKPVQVCMGCNQQMCVVJGHCEKNKVKGUVQUGG
JQYVJKPIUCTGIQKPIVQUGGYJGTGECTGKUTGEGKXGFCPFVJGPVJG[UKVFQYPCPFVCNM
CDQWVJGCNVJPGGFUCPFJGCNVJCUUGUUOGPV
6JG[çXGCNUQFQPGKVKP/GFKECTGYJGTGVJG[çXGIKXGPVJGOCPKEGNKVVNGRTGUETKRVKQP
FTWIDCIDWVKPQTFGTVQIGVKV[QWJCXGVQEQOGKPCPFDTKPICNNQH[QWTFTWIUUQ
VJCVVJG[ECPNC[VJGOQWV6JCVçUYJGPVJG[VCNN[QWVYJCVFTWIUVJGRCVKGPVUCTG
CEVWCNN[VCMKPI6JGPVJGFQEVQTOCMGUCPCUUGUUOGPVQHVJGRCVKGPVUFTWIEQORNK
CPEG6JGPVJG[IKXGVJGOCDCIYJKEJKUCPKEGNKVVNGRTGUGPV5Q+VJKPMKV
FGRGPFUQPJQY[QWCEVWCNN[IQCDQWVEQOOWPKECVKPIKV;QWçTGPQVIQKPIVQIGV
EQORNKCPEG+FQPçVVJKPMVJGTGçUCP[SWGUVKQPQPVJCVDWVYJCV[QWçTGVT[KPI
VQFQKUCVNGCUVIGVCUOCP[KPFKXKFWCNUKPVQUGG[QWTRJ[UKEKCPCU[QWECPVJG
RJ[UKEKCPUECPIGVCIQQFJGCNVJJKUVQT[TKIJVQHHVJGDCV2GTJCRU[QWECPIGVVJGO
KPVQCFKUGCUGOCPCIGOGPVRTQITCOQTKFGPVKH[YJGTGVJGKTOQUVCRRTQRTKCVGECTGKU
IQKPIVQDG
/T#NCP0(GTIWUQP+çFNKMGVQHQNNQYWRQPVJCV;QWFGUETKDGFXQNWPVCT[YC[U
KPYJKEJRGQRNGEQOGKPVQNQQMCVVJGHCEKNKVKGU*QYCDQWVEQORNGVKQPQHHQTOU!
*QYCDQWVCPPWCNEJGEMWRUQTCPKPKVKCNEJGEMWR!+H[QWJCFCPKPKVKCNEJGEMWR
CEQORNGVKQPQHVJGHQTOCVVJGDGIKPPKPI[QWçTGIQKPIVQJCXGUQOGGZRGPUG+U
VJGGORNQ[GTRC[KPIWRHTQPVUQOGQHVJGCFFKVKQPCNEQUVVJCVOKIJVDGKPXQNXGF
YKVJVJCV!
/T)TGGPYQQF6JGCFFKVKQPCNGZRGPUGVJCVKUKFGPVKHKGFD[VJGJGCNVJCUUGUUOGPV
QTVJGRGTKQFKEGZCOKUVJGEQUVQHVJGRTQXKFGTUMPQYKPIVJGJGCNVJUVCVWUQHVJGUG
7VKNK\CVKQP4GXKGY+UUWGU
KPFKXKFWCNUWRHTQPV7PFGTCECRKVCVGFCTTCPIGOGPVVJG[çTGCEVWCNN[IQKPIVQUCXG
OQPG[KPVJGNQPIVGTO5QYJCVVJG[çTGFQKPIKUWUKPIVJGKTOQPG[WRHTQPVCUCP
KPXGUVOGPVVQKFGPVKH[YJCVVJGJGCNVJUVCVWUKUUQVJCVVJG[HGGNKPVJGNQPITWPKVçU
IQKPIVQJGNRVJGOQRGTCVGWPFGTVJGKTECRKVCVKQPCTTCPIGOGPV+VçUWUWCNN[PQVVJG
JGCNVJRNCPUVJCVCTGRTQOQVKPIVJGFGOCPFUKFGQHKV+VçUVJGRTQXKFGTUVJGOUGNXGU
CPFVJGRTQXKFGTITQWRUVJCVCTGOQTGKPVQVJGFGOCPFEQORQPGPVCPFIGVVKPI
VJGOKPVQVJGTKIJVTGUQWTEGUTCVJGTVJCPJGCNVJRNCP
(TQOVJG(NQQT9JCVCTGVJGTQNGUQHCPPWCNEJGEMWRUQTEQORNGVKQPQHCHQTO!
/T)TGGPYQQF+VJCUDGGPCEQODKPCVKQPQHDQVJ6JG[VT[VQIGVCVNGCUVCHQTO
DWVCICKPYJCVVJG[çTGVT[KPIVQFQKUVQIGVVJCVRGTUQPKPHQTCPCEVWCNJGCNVJGZCO
+VçUPQVCTGCNEQORTGJGPUKXGQPG6JG[LWUVYCPVVQUGGUQOGQPGUKVVKPIFQYPYKVJ
VJGRJ[UKEKCPUVCTVKPIVQGUVCDNKUJVJCVTGNCVKQPUJKRUQDQVJQHVJGOJCXGCDGVVGT
WPFGTUVCPFKPIQHYJCVVJGKTJGCNVJPGGFUCTG
(TQOVJG(NQQT$QVJ[QWCPF$QDVCNMGFCDQWVVJGKORQTVCPEGQHIGVVKPIVJG
RTQXKFGTCITGGOGPVWPFGTUVCPFKPICPFRCTVKEKRCVKQPKPVJGUGRTQITCOU9QWNF
[QWEQOOGPVQPVJGTQNGQTTQNGUQHECRKVCVKQPQHVJGTGUQWTEGDCUGFTGNCVKXGXCNWG
UEJGFWNGQTRGTFKGOUKPQTFGTVQGPEQWTCIGVJGRTQXKFGTçURCTVKEKRCVKQPKPVJG
RTQITCOU!+PHCEVJQYGHHGEVKXGCTGVJG[!
/T)TGGPYQQF/CP[VKOGUCRGTUQPOC[CUMOGJQYDKIFQGUCRJ[UKEKCPUç
RCPGNJCXGVQDGKPQTFGTVQCEEGRVECRKVCVKQPKPQTFGTVQOCMGVJGOEJCPIG
RCVVGTPU!9GNN+IWGUUO[IGPGTCNXKGYKUVJGTGçUPQOCIKECNPWODGT#RJ[UKEKCP
ECPNQUGOQPG[CVCJWPFTGFOGODGTUQTGXGPCVQTECPNQUGOWEJOQTGCV
OGODGTU/[XKGYQPNKHGKUVJCV[QWPGGFVQJCXGCUKIPKHKECPVCOQWPVQH
VJCVRJ[UKEKCPçURTCEVKEGWPFGTCECRKVCVGFCTTCPIGOGPVDGHQTGVJGRJ[UKEKCP
CEVWCNN[UVCTVURC[KPICVVGPVKQPCPFEJCPIGUJKUQTJGTVTGCVOGPVRCVVGTPU+DGNKGXG
VJCV[QWçNNHKPFCRJ[UKEKCPVJCVKUECRKVCVGFHGGHQTUGTXKEGYKNNPQV
UWEEGGFDGECWUGVJGRJ[UKEKCPJCURCVVGTPJGQTUJGYKNNIGVJWTVWPFGTECRKVCVKQP
+HVJGRJ[UKEKCPEQPEGPVTCVGUQPVJGHGGHQTUGTXKEGUVTGCVOGPVRCVVGTPJGQTUJGYKNN
IGVJWTVWPFGTECRKVCVKQP+HVJGRJ[UKEKCPVTKGUVQEJCPIGVTGCVOGPVRCVVGTPUUQVJCV
JGQTUJGECPNKXGWPFGTECRKVCVKQPVJGRJ[UKEKCPYKNNJWTVVJGHGGHQTUGTXKEGUKFG+
VJKPMCVUQOGRQKPVVJCVRJ[UKEKCPJCUVQEQOOKVVQGKVJGTTGCNN[IGVVKPIKPVQ
ECRKVCVKQPNKMGQHJKUQTJGTRTCEVKEGQTUVC[KPICVäYJKEJFQGUPçV
TGCNN[KPHNWGPEGJKUQTJGTYJQNGHKPCPEKCNUKVWCVKQP+VJKPMVJGKFGCKUVQIGVCP
CUUGUUOGPVQHVJGRTQXKFGTCUVQYJCVJKUQTJGTCVVKVWFGKUVQYCTFUECRKVCVKQPCPF
VJGPVQVT[VQKPHNWGPEGJKOQTJGTHTQOVJCVRQKPV+FQPçVVJKPMVJGTGçUCP[KP
DGVYGGP;QWçTGGKVJGTKPVQKVXGT[NKVVNGQTCNQV#VVJGTGçULWUVVQQOWEJ
EQPHNKEVCPF[QWYQPçVUWEEGGF
4'%14&8QNWOG
/T&QDUQP+YQWNFDCUKECNN[CITGGYKVJVJCV+çXGJGCTFJQOGECTGRTQXKFGTUHQT
GZCORNGUC[[QWJCXGVQJCXGFKHHGTGPVPWTUGUFGNKXGTKPIJQOGECTGHQT/GFKECTG
RCVKGPVUYJGTG[QWçTGPQVECRKVCVGFVJCPVJQUGVJCVCTGFQKPIVJGECRKVCVGFITQWR
;QWECPçVGZRGEVQPGJWOCPDGKPIVQDGCDNGVQQRGTCVGWPFGTDQVJU[UVGOU+
VJKPMRJ[UKEKCPUHCEGVJGUCOGMKPFQHVJKPIU