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.
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.
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
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.
The Role of Household Capital Gains Taxation And Its Influence On The Aggregate Personal Income Tax Rate
Murrell, David; Myatt, Anthony
Parametric and Non-Parametric Tests for Scale Economies in a Regulated Industry: The Case of Cable Television
Law, 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.
The Behaviour of Productivity Growth Rates and Composition Bias in the Labour Input
MacGee, James; Yu, Weiqiu
The 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.
Health Care Investment by Provincial Governments
Ruggeri, Joe; Doucet, Melanie; Watson, Barry
Did the 1994/96 Employment Insurance Reforms Improve Labour Market Outcomes for Young People
Audas, Rick; Murrell, David
One of the goals of the Employment Insurance (El) changes during 1994/96 was to reduce the number of habitual, seasonal El users, and to re-channel such users into higher skilled, lower-unemployment occupations. The changes were expected to re-direct a large proportion of young people into more productive human capital acquisition and occupational-choice activity. This paper investigates, using a simple one-equation model, the factors associated with a polychotomous (multinomial) variable describing labour-market states for young people. The model uses year / province interaction variables to explain pre- and post-reform El policy changes, along with labour-market and socioeconomic control variables. This paper finds that labour market/human capital participation for young people improved steadily, from the 1980s through the late 1990s, for young people living as dependants within a family. But for young people living away from their parents, there was little long-run economic improvement. For this group, there is some evidence that the 1994/96 El reforms did play a small role in improving labour market / education outcomes.
Capital Income Taxation, Labour Supply and Work Effort
Ruggeri, G. C.; Yu, Weiqiu
Although 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.
Equity Aspects of Tax Preferences
Fougère, Maxime; Ruggeri, Giuseppe; Vincent, Carole
Is the Low Savings Rate of Households Indicative of Households in Crisis?
Myatt, Anthony; Murrell, David
Analysts 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.
Canadian Newsprint in the United States: A Multivariate Conintegration Analysis
Jee, Keewan; Yu, Weiqiu
In 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.
The Determinants of Provincial Minimum Wages
Dickson, Vaughan; Myatt, Tony
Investment in Natural Capital by the Federal Government in Canada
Ruggeri, Joe
A National Formulary for Canada
Hollis, Aidan; Law, Stephen, M.
This article analyzes the benefits and costs of replacing Canada's ten different provincial formularies with one single national formulary. The 2002 Romanow Commission on the Future of Health Care in Canada recommended that Canada should have a National Drug Agency which would maintain a national formulary, replacing the existing provincial formularies which balkanize drug markets across Canada. This recommendation has been in part incorporated into the "Common Drug Review" in which the provinces (excluding Québec) have agreed to undertake a single evaluation of all new drugs; provinces, however, retain their own formularies and decide which products to list. This balkanized approach to listing and insurance coverage of drugs substantially weakens the bargaining position of the provinces and leads to higher costs.
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.
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.
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.
Fiscal Illusion and the Perceived Price of Provincial Government Output in Canada
Dickson, Vaughan; Yu, Weiqiu
This paper examines if how governments finance themselves can influence the perceived price of and hence demand for government output. Using a standard model for government output and a panel data set often Canadian provinces for the period 1961 to 1992, we find that tax revenues are perceived more acutely than other major revenues (borrowing, federal transfers, investment income) and some taxes are recognized more than others. We also find learning by taxpayers (declining fiscal illusion) during the period and that lower increases in perceived tax prices lead to more seats for incumbent politicians.

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