Working Papers

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https://unbscholar.lib.unb.ca/handle/1882/12775

Working or discussion papers circulated publicly or among a group of peers. Certain disciplines, for example, economics, issue working papers in series. (URI: http://purl.org/coar/resource_type/c_8042)

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Systematic review protocol: Examining the effects of introducing pay-for-performance for primary care physicians on diabetes outcomes in single-payer healthcare systems
(2017) Gupta, Neeru; Ayles, Holly M.
Background: Although pay-for-performance (P4P) for diabetes care is increasingly common across health organizations, evidence of its effectiveness in improving population health and service delivery is deficient. This information gap is attributable in part to the heterogeneity of healthcare financing, covered medical conditions, care settings, and provider remuneration arrangements within and across countries. Objective: This paper outlines a protocol for a systematic review examining the effects of introducing P4P for physicians in primary care and community settings to support guideline- based diabetes care. Our aim is to reduce the heterogeneity of evidence presented that has deterred conclusiveness of previous reviews by narrowing the focus to disease-specific P4P schemes in single-payer healthcare insurance systems. This approach enables us to minimize the risk of unintended consequences of P4P such as physicians’ gaming the payment system. Methods: Our review systematically searches, appraises, and synthesizes the literature concentrating on whether P4P for primary care physicians leads to better diabetes outcomes in single-payer health systems. We search 10 electronic databases and manually scan the reference lists of review articles and other global health literature. We include primary studies evaluating the effects of introducing P4P for diabetes care among primary care physicians in countries of universal health coverage. Outcomes of interest include patient morbidity, avoidable hospitalization, premature death, and healthcare costs. Results: We have received funding from Diabetes Canada and the New Brunswick Health Research Foundation to conduct policy-actionable diabetes health services research. Database searches were conducted and full-texts screened by two reviewers in 2017. We aim to submit the review for publication in 2018. Conclusions: We are narratively synthesizing the data. Because of the wide range of outcomes considered, we do not expect to perform a meta-analysis.
Cross-national assessment of the associations between higher education and all-cause and diabetes-specific mortality: evidence from 35 OECD countries
(2018) Dunbar, James; Gupta, Neeru
Self-perceived mental health and its gendered and immigration associations
(2018) Aspinall, Mary; Gupta, Neeru
Background: Many research designs have analyzed various socioeconomic factors that influence a person’s physical health, such as diabetes. Whether or not these same factors are associated with a person’s mental health have received less attention. Some studies indicate that gender disparities and the migration process may be associated with differential mental health outcomes. Objective: This research examines the relationship between gender, immigrant status, and self-perceived mental health (SPMH) in the Canadian population aged 18 and over. Method: The analysis draws on the latest available Canadian Community Health Survey (CCHS) public use microdata file, which captured information from a nationally representative sample of 58,574 adults. Multivariate logistic regression was used to explore interactions of gender and immigrant status on SPMH, controlling for a range of socioeconomic variables including education and income. Survey weights were applied to allow for generalization of the results to the Canadian population. Results: The relationships between gender, immigrant status, and SPMH were significant, with females more likely to report good SPMH than men (odds ratio=1.16, p<0.05), and immigrants more likely to report good SPMH than non-immigrants (odds ratio=1.05). Discussion: Results indicate that the “healthy immigrant effect” often reported for diabetes and other physical health measures may also be protective for mental health. Women are more likely to rate their mental health as good. However, our examination did not account for clinical diagnosis of mental illness. More research is needed to inform evidence-based policy and practice guidelines in addressing potential gendered and immigration differences in both measured and perceived mental health.
Sexual minority status and the hospital burden of cardiometabolic diseases: protocol for an observational study using linked survey and hospital data
(2019) Gupta, Neeru; Seng, Zihao
This paper outlines a protocol for a national observational study examining the association between sexual identity and potentially avoidable hospital costs for diabetes and other cardiometabolic diseases. Our aim is to strengthen the evidence base on sexual minority status as a social determinant of health. We will use data from the Canadian Community Health Survey (CCHS) linked to multiple years of acute-care inpatient records from the Discharge Abstract Database (DAD), representing all provinces except Quebec. Sexual identity is captured in the CCHS among respondents ages 18 to 59. Hospital costs measured from DAD data are considered as an aggregate reflection of the frequency and intensity of use of hospital resources to meet essential medical needs. The study falls within a wider program of research with funding from Diabetes Canada, the New Brunswick Health Research Foundation, the Heart and Stroke Foundation of New Brunswick, and Diabetes Action Canada to conduct policy-actionable population health and health services research using existing databases from official statistical sources.
Social-Welfare Functions: Some Dissonant Notes
Levine, A. L.
The Notion of Equilibrium in Microeconomic Theory
Levine, A. L.
Recent Issues in Equalization Payments as They Pertain to Atlantic Canada
Murrell, David
Over the past three years a number of issues have cropped up, concerning equalization payments as they pertain to Atlantic Canada. This paper discusses the policy issues using confidential documents from the Department of Finance Canada under the federal Access-to-Information Act. These issues include: Premier John Hamm's Campaign for Fairness and the treatment of off-shore royalties, the imposition of the equalization ceiling in 2000-01, sources of revisions to equalization payments, forecasts of equalization transfers to 2005-06, and the implications of the recent downward revisions in population, in the 2001 Census, on future payments.
New Brunswick Businesses are Not Awash in Government Subsidies
Ruggeri, G. C.
Where Has the Canadian Public Health Sector Gone?: The Optimal Mix of Patient and Community Oriented Health Programs and Policies
Brown, Malcolm, C.
In health terms, the post-war period in Canada has been noteworthy mainly for the introduction and maintenance of national health insurance (NHI); but the period has also been one of significant paradigm changes concerning public health. Before the introduction of NHI (roughly 1945-1970), public health was eclipsed by curative health objectives; with the objective of introducing medicare dominating all policy options designed to prevent diseases and injuries from occurring, or to promote healthy lifestyles and living environments. The decade following the introduction of medicare (the 1970s) was one of policy concern about health costs in the context of rapidly increasing prices. During this period, interest was rekindled in public health, not as a mechanism for promoting better health but as a mechanism for constraining curative health expenditures. By the beginning of the 1980s, this interest declined, and two new paradigms emerged. One was the paradigm of population health maximization via evidence based medicine - a paradigm in which containment of health sector expenditures remained the main objective of policy but reliance on public health ceased to be a primary cost containment tool. The other paradigm was health promotion, in which the idea of health policy was replaced by that of healthy public policy. Integral to both 1980s paradigms was recognition that public health was no longer appropriately defined as a sectoral concept, and no longer pertinent to health sector policies concerned mainly with the funding of curative services. Policy-makers and health analysts are currently struggling to find the best ways to define public health policy in a world where health and non-health goals are becoming increasingly comparable, and where non-health policies are as important as health ones in defining the standard of a health.
The Location Choice of New Immigrants to Canada: The Role of Ethnic Networks
McDonald, James, Ted
The focus of this paper is on the determinants of the initial location decision of recent immigrants to Canada. Particular attention is given to the role of 'ethnic networks' in this location decision. The ethnic network - the concentration of people in the same geographic area who are of similar ethnic background, culture and language - can be an important source of financial or personal support, information and guidance, and social mores. Evidence is found that the presence of ethnic networks does have a significant effect on the location decisions of recent immigrants, but the magnitude of the effects depends on personal characteristics of the immigrant such as language and education.
Federal Fiscal Policy & Interregional Redistribution
Ruggeri, Joe; Watson, Barry
The Significance of Visceral Phenomena and Emotions in Decision-Making in Economic Analysis
Levin, Larry
The Effect of the Harmonized Sales Tax on Consumer Prices and Spending in Atlantic Canada
Murrell, D.; Yu, W.
This paper examines the effect of the Harmonized Sales Tax (HST) on consumer prices and spending from April 1997 to March 1999. Using aggregate and disaggregate (eight-component) consumer price index (CPI) data for the three participating Atlantic Canada provinces and for Ontario (as the "control "province), we conduct counter-factual analysis and find that, ceteris paribus, consumer prices were lower in all three participating provinces during this period. We also find that political support for the HSTwas relatively stronger in Newfoundland, the province in which consumers have benefited the most from the HST.
Regional Dimensions of Federal Income Tax Cuts
Fougère, Maxime; Ruggeri, G. C.
Measures of Obesity for Canada and New Brunswick
Edwards, Mike; Ruggeri, Joe; Yu, Weiqiu
Federal Fiscal Balances and Redistribution in Canada, 1992-96
Ruggeri, G. C.; Yu, Weiqiu
This article identifies the major methodological issues involved in the calculation of federal fiscal balances by province. Using data from the Provincial Economic Accounts (PEA) and National Income Accounts, we calculate four sets of balances for the period 1992-1996, namely basic balances, primary balances, balanced budget balances with tax increases and balanced budget balances with spending cuts, under different assumptions. For comparison purposes, we also include federal fiscal balances contained in the PEA based on the cash-flow approach. The results show that federal fiscal balances by province vary significantly from one method to another. In particular, the basic balances calculated using our approach yield substantially lower gains to the net beneficiary provinces and lower costs to the net contributor provinces than balances based on the cash-flow approach. Eliminating the interest on the public debt or the federal deficit increases the contributions by the "better off" provinces and reduces the gains to the net beneficiary provinces. We also calculate some indices of redistribution among provinces generated by the federal fisc and find that the degree of redistribution was modest under all methods of calculations.
Student Fees, Subsidies and Enrolment in Canadian Universities, 1962-1995
Dickson, Vaughan
This paper examines how student fees, subsidies and enrolment have evolved in Canadian universities over the period 1962 to 1995. A model is developed, and tested with a panel data set often provinces, wherein student fees (subsidies) are the outcome of provincial governments balancing the interests of students and taxpayers. Among the conclusions are that student fees initially fall as student numbers increase but then rise, that tighter provincial fiscal environments increase fees, and that more pressure for K-12 education increases fees. We also find that enrolments are more sensitive to changes in student aid than to changes in tuition.
A Measure of Interregional Redistribution
Ruggeri, G. C.; Yu, Weiqiu
This paper develops a disaggregated index of interregional distribution generated by federal fiscal activity based on a comparison between relative federal revenues and expenditures assigned to various regions and the pattern of income disparities among regions. To explore the properties of this index, we present three special cases under known degrees of distribution and calculate the indices using the Canadian data for 1996. The local indices are then aggregated to derive a global index qf interregional redistribution. Our results show that the federal fiscal system in 1996 delivered a degree of interregional redistribution 1.8 times what would have been generated under equal per capital expenditures by region and nearly half of the redistribution that equalizes the per capita income via federal expenditures.
The Role of Household Capital Gains Taxation And Its Influence On The Aggregate Personal Income Tax Rate
Murrell, David; Myatt, Anthony
Education Policies and Economic Growth
Benos, Nikos
This paper studies the general equilibrium implications of various types of education policy. In particular, we examine individual-specific vouchers (ISV), individual-specific transfers (1ST) and public investment on economy-wide human capital (GH). Individual-specific vouchers augment inherited private education spending, while individual-specific transfers are standard cash transfers, which increase private income. Public investment on economy-wide human capital provides economy-wide externalities to individual human capital accumulation. The context is an overlapping generations growth model with second-best policy. In particular, the government chooses its tax policy and the allocation of tax revenues among the three types of education policy, subject to the competitive decentralized equilibrium. Numerical simulations show that it is socially optimal to provide a large voucher on inherited individual education expenditures and spend heavily on economy-wide human capital accumulation. In addition, it is optimal to finance government spending by a low proportional tax on initial human capital and a high lump-sum tax.

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