ABSTRACT
The industry diversity thesis of economic resilience to economic shocks is embedded in community development policy across Australia. The idea being that in the event of an economic shock some industries will prove more recession-proof than others. The greater the industry diversity, the greater the likelihood of off-setting industry effects, resulting in greater economic resilience. The COVID-19 pandemic and the associated restrictions created a unique natural experiment to explore whether the industry diversity thesis holds true under the conditions of a global health pandemic. In this policy paper, we use JobKeeper applications as a proxy for decreased economic resilience. We explore if Australian local government areas (LGAs) with higher industry diversity had less necessity for JobKeeper. We also briefly consider if concentrations of certain industries acted as a better economic buffer to the COVID-19 economic shock. We observe that as diversity increases, economic resilience strengthens except for Victoria (where the association is inverted). This observation has important implications for current and future policy formation and implementation across all layers of government. © 2023 The Authors. Economic Papers;A journal of applied economics and policy published by John Wiley & Sons Australia, Ltd on behalf of The Economic Society of Australia.
ABSTRACT
Objectives: 1. Compare recent palliative care state policies adopted by different states. 2. Assess the transferability of other states' palliative care policies to a provider's own state. Original Research Background: In the United States, there are significant opportunities to advance palliative care (PC) access and quality at the state level. Recently, there has been a rise in PC policies, many of which have stemmed from increased state-level advocacy by palliative care champions. Research Objectives: In collaboration with the Center to Advance Palliative Care, the Palliative Care State Policy GPS was created to support research on palliative care policy and to encourage policy innovation aimed at ameliorating disparities in access and reforming palliative care quality and education. Methods: Three individuals searched LexisNexis and state health departments with search terms including “palliative care,” “home care,” “home and community-based services,” and “pain management” to find enacted and pending policies that affect PC for each state. The database will be automatically updated with new legislation and regulations by periodic input of our search terms into a search function on Westlaw. Results: Preliminary data have been collected for thirteen states, the U.S. territories, and the Indian Health Service. The database is expected to be publicly accessible by November 1, 2020. Current data shows heterogeneity among states regarding PC policy. Some states, such as New York, have been active in legislating around PC, while other states and territories have lagged. In 2019 and 2020, 56 state laws and regulations have been enacted or proposed in seven states (New York, Utah, Texas, Louisiana, Michigan, Oregon, and Vermont). Additionally, the COVID-19 pandemic has encouraged policymaking in telemedicine and expansion of the PC workforce, both of which have positive implications for PC. Conclusion and Implications for Research, Policy, or Practice: The creation of the Palliative Care State Policy GPS is critical to understanding how states are adopting PC policies over time, identifying barriers to policy adoption, and developing strategies to improve quality and access to PC.
ABSTRACT
The COVID-19 pandemic has changed the way we deliver healthcare. During 'lockdown' all but the most urgent face-toface (F2F) consultations stopped. There will be a continuing need for innovation to maintain services, and teledermatology offers the potential to help meet demand, while continuing to maintain social distancing. We report the use of a store-andforward teledermatology platform to facilitate virtual asynchronous consultations. The platform was developed and piloted across two health boards, with initial use focused on return consultations. The restrictions imposed during the pandemic prompted its use on a larger scale, with the addition of a specific proforma for new consultations. Patients are invited to register using a web-based app, and then have a 5-day window to submit information and pictures to an assigned clinician. The clinician then responds within an agreed timeframe, and a PDF of the consultation is sent to the general practitioner automatically. The system can integrate with patientmanagement systems, although at the time of this audit it was only integrated in one of two health boards. During an 11-week period from late March 2020, 405 consultations (new 297;return 108) were completed. In total, 292 consultations involved the assessment of lesions, most referred as suspected cancers. Patients of all ages participated successfully, with 31% over the age of 60 years. Parents of 12 children also successfully participated. Responses to 219 consultations were completed from home by a clinician, highlighting the potential for the system to facilitate remote working. Outcomes from the virtual consultations included further virtual review (16%), F2F review (47%), direct surgery (12%), discharge (22%) and other treatment/investigations (3%). The majority of those needing F2F review were scheduled for routine follow-up, although 29% were booked as urgent to confirm diagnosis, typically where image quality was not sufficient for diagnostic certainty. The average time taken by the clinician was 10 min per consultation vs. 13 min for equivalent F2F. However, these timings were taken without the benefit of full system integration. Patient satisfaction was good, with 82% of respondents reporting ease of use. Forty-two per cent reported that they would normally have had to miss work to attend the clinic. The system also confers environmental benefits with a total of 5758 km of patient travel saved. This pandemic has resulted in a paradigm shift in the way we deliver outpatient care. Virtual asynchronous consultations, within an integrated dermatology service, provide an efficient alternative to some F2F consultations.