Working Papers
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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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Item 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.Item Self-perceived mental health and its gendered and immigration associations(2018) Aspinall, Mary; Gupta, NeeruBackground: 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.Item 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, ZihaoThis 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.Item Capital Income Taxation, Labour Supply and Work EffortRuggeri, G. C.; Yu, WeiqiuAlthough it is well-known that, in life cycle models of consumption and labour supply, capital income taxation affects the labour supply through the normal income effect, this interaction between capital income taxation and labour market behaviour is usually confined to the voluntary savings of consumers who wish to smooth the pattern of consumption through their lifetime. We show in this paper that the interaction maybe widespread. Three channels through which capital income taxation may affect labour market behaviour are identified: first, capital income taxes may alter the lifetime labour supply when workers are constrained on hours of work; second, they may affect labour supply in the case where consumers target a certain level of lifetime consumption; finally, they may influence work effort in an efficiency wage model.Item The Equity Effects of Tax Reform in New BrunswickRuggeri, Joe; Bourgeois, J. P.Item Federal Fiscal Balances and Redistribution in Canada, 1992-96Ruggeri, G. C.; Yu, WeiqiuThis 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.Item The Determinants of Provincial Minimum WagesDickson, Vaughan; Myatt, TonyItem Canadian Newsprint in the United States: A Multivariate Conintegration AnalysisJee, Keewan; Yu, WeiqiuIn this paper, Johansen multivariate cointegration tests are adopted to investigate the U.S. demand for Canadian newsprint using monthly data from May 1988 to December 1996 Preliminary data analysis shows that all data are non-stationary which implies that previous results based on simple ordinary least squares are spurious. Johansen multivariate cointegration techniques allow for identifying a long-run relationship as well as a short-run relationship via an error correction model. Among the determinants are the export price of Canadian newsprint to the US., the exchange rate between the two countries, US. personal disposable income, and US. newsprint price.Item Is the Low Savings Rate of Households Indicative of Households in Crisis?Myatt, Anthony; Murrell, DavidAnalysts have pointed towards increasing household debt, increasing personal bankruptcies, and a declining household savings rate as indicators of a financial crisis in Canadian households. Our conclusion is that, at this point in time, none of these constitute clear evidence of a problem. In particular household debt is more than offset by increases in household financial assets, and the low savings rate is driven both by short run dynamics and increasing real net worth of households. The high level of bankruptcies could be driven by a liberalisation of bankruptcy laws (1992). We note, however, that real PDI per capita has declined since 1989. This may be producing signs of crisis elsewhere - perhaps in increased poverty rates, or increased inequality amongst households.Item Equity Aspects of Tax PreferencesFougère, Maxime; Ruggeri, Giuseppe; Vincent, CaroleItem Economic Indicators, Units of Measurement and ConvergenceRuggeri, Joe; Huang, HaifangItem Halfway Technologies, Quality of Life, and Affordable Public Health Policy: Biotechnology Drug Developments for Multiple SclerosisBrown, Malcolm, C.; Jardine-Tweedie, LeanneThe cost control problems associated with funding half-way medical technologies in national health insurance systems are considered, in the context of analyzing the effectiveness, efficiency and equity implications of publicly funding the new biotechnology drugs for treating multiple sclerosis. It is suggested that, while lip service is played to all three types of assessment for formulating public policy, in practice decision-making is based on the effectiveness and efficiency evidence only. The consequence is an inability to formulate resource allocation decisions where distributional health effects among patients are involved. The development of equity norms would not only generate more consistency and justification to distributional decisions, but also increase the ability of policy makers to make distributional choices explicitly in contexts where the implications of doing so implicitly are spiralling health care costs. For the purpose of increased cost control, almost any set of explicit equity norms would do, which does not mean to say that all equity norms are equally appealing, either philosophically or electorally. The development of explicit and socially acceptable equity norms is a high priority goal, even though their development requires more explicit judgements about what constitutes fair collective funding arrangements than either analysts or society have been want to make.Item Parametric and Non-Parametric Tests for Scale Economies in a Regulated Industry: The Case of Cable TelevisionLaw, Stephen, M.; Nolan, James, P.We examine a situation where parametric and non-parametric approaches to the study of production and optimal scale can be used as complements, rather than substitutes. We illustrate this concept with data from the cable television industry in an evaluation of the timeliness of deregulation. Although we begin with a large sample offering adequate degrees of freedom for parametric estimation, important regulatory policy issues and the structure of the industry lead us to consider parameter estimation over sub-samples. Some sub-samples are small enough that parametric models cannot guarantee reliable estimates. To deal with this problem, we estimate production parameters non-parametric ally using various forms of data envelopment analysis (DEA). Since it is not statistical in nature, the use of DEA is not constrained by degrees of freedom. Not only do the non-parametric estimates shed light on important characteristics of the industry sub-samples when considered in isolation, we also find that on aggregate they agree with parametric estimates when these can be computed.Item The Behaviour of Productivity Growth Rates and Composition Bias in the Labour InputMacGee, James; Yu, WeiqiuThe conventionally calculated Solow residual has been used as a measure of exogenous productivity shocks that contribute to the business cycle. However recently this residual has been shown to be endogenous and has led to the conclusion that the aggregate economy is characterized by increasing returns to scale and imperfect competition. Another hypothesis is that the Solow residual may fail to be exogenous due to measurement errors in labour and capital. Using an efficiency hours series corrected for the composition bias in the labour force and a capital series adjusted for capacity utilization for Canada, we find that adjusting the Solow residualfor cyclical variations in labour and capital inputs over the business cycle re-establishes exogeneity ofproductivity shocks.Item Health Care Investment by Provincial GovernmentsRuggeri, Joe; Doucet, Melanie; Watson, BarryItem