Suchergebnisse

Imagining the future is a tantalising thought, considering that we will never truly know what lies ahead. Despite this inability, envisioning the future has not remained trapped in the realm of mere science fiction fantasies, but is increasingly attempted by organisations, academics and governments. This thesis uses scenario planning to ask what will the future of the New Zealand tourism workforce look like in the year 2035. Scenario planning, as a method of futures studies, is an increasingly popular approach to envisioning the future and draws upon key drivers of change in the present to formulate plausible future scenarios. This provides decision makers with a space for discussion and stretches their thinking through rich storylines. This thesis adds valuable insight to both areas of workforce planning, and New Zealand's valuable tourism industry and its workforce. It takes an alternatively qualitative scenario approach to holistically explore this topic. The year 2035 was chosen to push the current industry discussions around the Tourism 2025 strategy even further into the future. A modified Delphi method guided the research, based on a similar scenario planning study by Solnet, Baum, Kralj, Robinson, Ritchie, and Olsen (2013) which focused on the tourism workforce of the Asia-Pacific region. This method adds truthfulness to the research and involves three rounds of surveys that draw upon the knowledge and consensus of experts within the tourism and workforce fields in New Zealand. From a list of ten drivers, immigration policies and the growing Asian market emerged as the most important and formed the basis for the four alternative future scenarios. "Manaakitanga is Found Here" presents a world of closed immigration and a niche Asian tourist market, where the workforce relies on, and celebrates, local knowledge and culture. "Pick of the Labour Crop" encourages a flexible workforce for private profit within open immigration settings with a niche Asian market. "Struggling for Respect" warns of a future where tourism lacks national strategic importance with a struggling workforce, amongst closed immigration policies and a mass Asian market. Finally, "Cheap and Plentiful" explores how open immigration and a mass Asian market could push a flexible workforce and a cheaper tourism product, which damages the country's industry and image. The study reveals that some scenarios are more desirable than others, but regardless of which scenario unfolds, they each present various challenges and opportunities for the workforce.They emphasis the unpredictable nature of the future and stress the importance of flexibility in order to respond and adapt to changes. They also highlight the necessity of seeking a balanced solution for the workforce and striving for a quality tourism product that respectfully integrates our Māori culture.

Why have some Republican‐controlled states controlled expanded Medicaid while others have not? Research into state expansion decisions has emphasized partisanship, interest groups, legislative professionalization, and available resources. In contrast, we evaluate the impact of political institutions, which are rules that govern how officials reach policy decisions. We explain how different state institutional structures can lead to different expansion decisions, given similar partisan control patterns. We describe varying gubernatorial powers over Medicaid programs and analyze the potential of voter‐led initiatives to impose expansion on recalcitrant elected officials. Finally, we describe how politicians change rules to make it more likely that their preferences are enacted. Overall, focusing on institutions in addition to partisanship and interest groups more effectively illuminates the expansion prospects in holdout states. This allows for an effective illustration of potential roadmaps and roadblocks for pursuing both Medicaid expansion and other state‐level health reforms that can improve access and equity of health care.

In January 2018, the Center for Medicare and Medicaid Services (CMS) released guidance that encouraged states to submit Section 1115 waivers that impose work requirements on some Medicaid beneficiaries. To evaluate the potential impact of a policy, we need to accurately predict both how far a policy will spread and how durable it will prove over time. This commentary draws upon recent political science scholarship to describe potential constraints that changes in state-level partisan control can impose on CMS's current waiver strategy, as well as how state-level constraints might interact with judicial review to further limit the policy's spread.

This study examines temporal trends in the use and outcomes of cardiac procedures for patients hospitalized with acute myocardial infarction in Department of Veterans Affairs (VA) hospitals with and without invasive cardiac services. Between 1988 and 1994, there was striking overall growth in the use of cardiac procedures in the VA. Over this time period, the authors found persistent variation in the use of cardiac procedures but diminished differences in patient survival among patients admitted to different types of hospitals. Growth of cardiac procedure use and improvements in patient survival were most significant in hospitals without on-site invasive cardiac services. We were unable to determine whether survival gains were associated with increased procedure use or unmeasured improvements in the process of care. These trends raise intriguing questions about access to and outcomes of cardiac procedures in health systems composed of hospitals with and without a full complement of on-site invasive cardiac services.

To describe the malpractice environment as it relates to defensive medicine, the authors studied omission-related claims from a large physician-owned malpractice insurer covering 70 percent of physicians in a northeastern state. During a 12-year period (1977-1989), claims resulting from alleged diagnostic omissions were considered important in less than 9 percent of claims and of central importance in 4 percent. Compared with other claim types, omission-related claims were more likely to be paid, had a higher median payment, and were more often associated with significant patient injury or death; the association with more frequent payments remained after controlling for physician specialty, geographic region, and degree of patient injury. Malpractice claims alleging diagnostic and monitoring omissions are relatively uncommon but appear difficult to defend relative to other claim types. Taken in light of the changing health care environment, these results highlight the limits of defensive medicine and support an expanded focus for medical liability reform.

An implementation analysis conducted as part of a 2-year experimental study of residential and nonresidential treatment programs for the dually diagnosed homeless found significant differ ences in client engagement and retention, as well as unexpected variations in the treatment conditions. Fully 40% of subjects assigned to either treatmentfailed to become engaged for even one day, although a significantly higher percentage of those assigned to the residential program than the nonresidential program graduated from the first 3-month phase of treatment. The analysis revealed significant differences in the type and amount of services provided by the two treatment programs, as well as potentially important difficulties in program management. Such process data are valuable toolsfor understanding client outcomes and interpreting experimental results.