This final chapter first takes a brief look at some speculative ideas for propulsion that currently lie at or beyond the edge of known physics. I then return to reality and summarize the main challenges of interstellar travel along with the most promising solutions we have considered in this book. I look again at the big picture of what we want to achieve and its ethical implications, and finish by briefly describing some steps that could be taken to get us on our way to the stars.

There are diverse motivations for travelling to the stars, both scientific and non-scientific. In this chapter we will examine primarily the scientific motivations, in particular what we can learn about stars and exoplanets as well as how to look for signs of extraterrestrial life. I give a brief survey of the nearest stars and their planets, in particular the nearest star system, Alpha Centauri, which happens to be a triple star system with at least one planet. We will also look briefly at some of the science a spacecraft can do en route to a star as it moves through the interstellar medium.

Chapter 3.2 covers the way hospitals are paid. Methods for paying hospitals vary across countries and include fee-for-service, block contracts, line-item budgeting (where purchasers specify exactly what funds are used for), and activity-based funding (with a fixed rate for each episode of care independent of the hospital’s costs of care). Increasingly, pay-for-performance elements are also used. Key learning includes that

• Third-party purchasers: government agencies, social health insurance funds, or insurance companies provide the bulk of hospital revenue giving them levers to shape provision.

• Purchasers and hospitals have distinct objectives that are not always aligned — purchasers will pursue the best quality of care at the lowest price for their covered population while hospitals seek stable revenue streams to cover their costs.

• Information asymmetries give hospitals advantages over purchasers.

• Purchasers use payment methods and financial rewards to incentivize the volume and quality of care, patient-mix and management effort they want. There are complex challenges around

• – Specifying the details

• – Negotiating effective contracts, and

• – Managing payment systems.

• Monitoring outputs and safeguarding quality requires structures and systems which are costly.

• Reforming funding or transitioning from one payment model to another is often a long process that demands sophisticated design and careful implementation.

This chapter is about the dominant intellectual framework of International Relations (IR) scholarship on religion, as illustrated by the tensions between multiculturalism and genealogy within the secularism debate. It shows how the critique of liberal secularism fundamentally restructured the knowledge basis for religion in IR and opened up space to engage with religion in new ways. The chapter continues to show how that space became filled with a particular kind of scholarship seeking to rehabilitate the concept and argues that, despite claims to the contrary, this scholarship has narrowed rather than broadened the scope of available perspectives, epistemes, and ontologies of religion. It is necessary to explore this legacy in order to understand the foundational problems currently embedded within IR scholarship on religion as well as enable an assessment of the damage done to IR theorizing and the lost potential of current scholarship on religion in other disciplines. This connects to the main argument as it forecasts the inherent issues and costs entailed in efforts to recognize and engage with religion in IR more broadly.

The payload can be considered as everything the spacecraft carries that is not related to propulsion. We examined navigation and communication in previous chapters. Here we look at the scientific instruments that an interstellar spacecraft may carry and what they would be used for, consider possible sources of onboard power, and outline the need for autonomous control of the spacecraft. We also touch briefly on the idea of spreading a mission’s payload across multiple spacecraft in the form of swarms or relays.

To fulfil its mission, a spacecraft needs to know where it is and how fast it is moving. This is the goal of navigation. Here we look first at how navigation is done for spacecraft in the solar system, using internal measurements as well as artificial signals sent from the Earth acting as navigation beacons. The latter has some relation to the concept of global navigation satellite systems such as GPS, which we also take a brief look at. At interstellar distances, signals from the Earth would be too weak and take too long to arrive, so interstellar spacecraft will have to navigate autonomously. We will see how this can be done using measurements of the positions or radial velocities of stars, by exploiting aberration and parallax, or by timing pulses from neutron stars.

Chapter 3.5 reflects on how to use payment mechanisms to support the integration of care. Integrated care is about better management of the care patients receive in different settings (primary, secondary) and from different specialists and teams. It is particularly important for patients with multi-morbidity and chronic long-term needs, and as populations age. Key learning includes that

• Health systems’ payment models can play an important role in incentivizing integrated care.

• Purchasers are now testing innovative payment models (e.g. pay-for-coordination or P4C) which explore how to foster better coordination. These models include

• – Appointing a ‘budget holder’ for a patient so a case manager and /or multidisciplinary team has oversight of all care

• – Bundling payments to single providers so that the multiple services a patient uses are better linked and

• – Bundling payments for patients being treated by multiple providers, creating joint budget responsibility and a need to work together and avoid duplication.

• Policy-makers would do well to focus on careful design of information systems to underpin payment schemes because

• – Information sharing supports clinical effectiveness

• – Quality indicators allow purchasers to tie bonuses or penalties to integration

• – Monitoring activity and health outcomes helps assess value for money

• – Tracking the distributional consequences of incentive schemes is crucial in protecting equity

• – Robust evaluation tools allow immediate lessons to be shared and will capture changes over time and across the healthcare system.

• Health systems need to embed financial incentives as part of a broader system approach. Critical elements include

• – Committed leadership

• – Effective communication among providers

• – Structural integration, either through coordinating mechanisms that link provider roles or by the formation of new entities with single management teams.