SEDAP: Research Paper Abstracts (2002)

  1. Alternative Pasts, Possible Futures: A "What If" Study of the Effects of Fertility on the Canadian Population and Labour Force
    Frank T. Denton, Christine H. Feaver, Byron G. Spencer

  2. The "baby boom" that followed World War II, and the subsequent "baby bust", have cast a long shadow over the Canadian population, society, and economy. Drawing on a series of counterfactual projections, this paper considers what the year 2001 would have looked like if things had been different if there had been no baby boom or no bust, or if the bust had been delayed, to take three examples. The paper then considers what will happen in the coming decades under a number of alternative assumptions. A major finding is that the boom had much less impact on the 2001 age structure of the population and labour force than did the bust that followed. For the future, population aging, slower rates of growth, and increased dependency ratios are likely features, but one should be careful not to overestimate the prospective "dependency burden".

  3. Baby-Boom Aging and Average Living Standards
    William Scarth and Malick Souare
  4. A calibrated overlapping generations model is used to investigate the effect on living standards of the aging baby boom. The relative scarcity of labor when baby boomers are old raises the wage-rental ratio by an amount that is sufficient to ensure that the post baby-boom generation can enjoy a modest increase in living standards - despite facing higher taxes. Nevertheless, the baby-boom cohort itself suffers a drop in consumption, and when the two generations are considered as a group, overall living standards fall by a modest amount. These results are robust to several changes in specification: the existence of liquidity constraints, alternative assumptions regarding individuals' expectations concerning future interest rates, and different fiscal policies concerning the tax treatment of private saving for retirement. Policy initiatives that bring significant hardship today to avoid a future "crisis" are not supported by the standard overlapping generations model.

  5. The Invisible Retirement of Women
    Lynn McDonald
  6. In tracing the history of retirement in Canada it is evident that retirement is a social institution that reflects the social forces that defined the 20th century – the rise of industrialism, the devastation of the Great Depression and World War II, the growth of welfare, economic globalization, the spread of mass unemployment and the fiscal crisis of the welfare state. It is also the history of men's retirement, not women's retirement. With the increase in the labour force participation rates of women, it is only recently that retirement has become a meaningful concept to apply to some women. Indeed, the concept of retirement has no particular meaning outside of paid labour and pension policy. It also has little meaning in the context of serial employment over a lifetime.

    By employing a gendered relations approach to the history of retirement in Canada it rapidly becomes evident that retirement is not a concept one would readily apply to women over the course of its early development. Preceded by "stepping down", retirement in most historical accounts means leaving the paid labour force with a pension, the latter factor making labor force withdrawal economically feasible. In reviewing women's behaviour patterns in relation to men's from pre-industrial times to the 1960s, the most that can be said is that women were invisible in the development of retirement because its evolution into a social institution occurred within the context of the labor market where women were least likely to be found. Women's retirement was tied to the breadwinner model of the family, a model embedded in the Annuities Act of 1908 and operationalized in the administration of the Old Age Pension Act of 1927. In tracing the history of retirement it seems clear that retirement was a social institution developed mainly for men. Women were, at most, ancillary to the process.

    An analysis of the history of women's retirement is important for many reasons. The history of women and retirement indicates that a model of women's retirement must be driven by theory that, at minimum, takes into account gender relations and the concomitant gender system as it changes over time. Such a model might help to explain why women have spent the last twenty years playing "pension catch-up" to men, or might explain how the progressive erosion of the breadwinner model is likely to affect women's retirement in the future (Beck, 1992; Giddens, 1992; Beck and Beck-Gernsheim, 1995).

  7. The Impact of Reference Pricing of Cardiovascular Drugs on Health Care Costs and Health Outcomes: Evidence from British Columbia--Volume I: Summary
    Paul V. Grootendorst, Lisa R. Dolovich, Anne M. Holbrook, Adrian R. Levy, Bernie J. O'Brien
  8. Objective: We estimate the effects of Reference Pricing, a drug cost control policy introduced by the BC Ministry of Health Pharmacare program in 1995, on its program expenditures for seniors, out of pocket costs paid by its senior beneficiaries, indicators of beneficiary health status and attendant Ministry of Health expenditures on physicians and hospitals services. Rationale: Reference pricing (RP) limits the reimbursement of a group of drugs with similar therapeutic effect but different active ingredients to a fixed "reference price". The setting of the reference price varies by jurisdiction but typically is based on an average of the lowest cost "reference standard" drugs within the group. Critics of RP contend that the partially subsidized and fully subsidized (reference standard) drugs are not therapeutically interchangeable, and therefore patient health will be compromised and use of other non-pharmacologic health services may increase as a result, thus partially or wholly offsetting any potential cost savings from the policy.

    Findings: The application of RP to 3 groups of cardiac drugs produced annualized savings to Pharmacare of about $7.7 million, or 3.6% of the $213.7 million that Pharmacare spent on drugs for seniors (not including dispensing fees) in 1997. The additional costs for physician consultations were modest, around $500,000 in the subsample of seniors we studied, from the introduction of the RP plans to March 1998, although the costs could be greater, perhaps up to twice this amount, if we accounted for all seniors exposed to the RP over the same period. We found no effects of RP on mortality, or premature admission to a longterm care facility.

    Seniors using the nitrate drugs for angina that were no longer fully subsidized when RP was introduced faced a higher probability in the short run of using medicines to deal with acute exacerbations of angina and in the longer run having bypass surgery or other revascularization procedures. No long run effects of morbidity were observed for the application of RP to two different types of anti-hypertensive medications, although there was a short run increase in the rate of revascularizations among those taking 1 type of anti-hypertensive: the ACE inhibitors. The results of these morbidity models should be seen as tentative, until these results can be replicated using alternative estimation strategies.

    Conclusions: The introduction of RP can indeed reduce Ministry of Health drug expenditures. The effects of RP on patient morbidity remain to be fully investigated before definitive policy recommendations can be offered.

  9. The Impact of Reference Pricing of Cardiovascular Drugs on Health Care Costs and Health Outcomes: Evidence from British Columbia--Volume II: Technical Report
    Paul V. Grootendorst, Lisa R. Dolovich, Anne M. Holbrook, Adrian R. Levy, Bernie J. O'Brien
  10. (see SEDAP 70 for abstract)

  11. The Impact of Reference Pricing of Cardiovascular Drugs on Health Care Costs and Health Outcomes: Evidence from British Columbia--Volume III: ACE and CCB Literature Review
    Lisa R. Dolovich, Anne M. Holbrook, Margaret Woodruff
  12. (see SEDAP 70 for abstract)

  13. Do Drug Plans Matter? Effects of Drug Plan Eligibility on Drug Use Among the Elderly, Social Assistance Recipients and the General Population
    Paul V. Grootendorst and Mitchell Levine
  14. The 1984 Canada Health Act does not require that the provinces subsidize prescription drugs. Many provinces do, however, provide categorical coverage to the elderly, social assistance recipients and others, although the generosity of coverage is highly variable. A system of parallel private insurance covers the non-elderly ineligible for social assistance. In this study, we assessed the socio- economic, health and demographic determinants of private drug insurance. We also assessed the effect of inter-provincial variations in drug insurance coverage for the elderly and low income on variations in drug insurance coverage for the elderly and low income on their drug use. In addition, using instrumental variables methods, we considered the effect of prescription drug insurance coverage status on drug use in the non-elderly population ineligible for social assistance. Consistent with the previous literature, we find that for most seniors and non-indigent, drug coverage has only minor effects on drug use. The drug use of social assistance recipients was, however, sensitive to even relatively modest copayments of $0-$6.

  15. Living Alone and Living with Children: The Living Arrangements of Canadian and Chinese-Canadian Seniors
    Michael A. Pacey
  16. Living arrangements have the potential to tell us far more than simply who lives with whom. Whether a senior lives alone, with a spouse, or with children will provide potentially distinct social support possibilities. From a policy perspective, the particular mix of these living arrangements also provides clues to the need for formal services. While work has been done on how income, gender and age shape the living arrangements of Canadian seniors, relatively little research has explored how ethnicity, language skill and immigration status further mediate living arrangements. Given the future combination of population aging and continued shifts in the source and type of immigration to Canada, additional research on how ethnicity and factors associated with immigration affect living arrangements is also warranted.

    In this paper I explore the relationship between characteristics of Canadian seniors and their living arrangements. Ethnicity and immigration are further explored by focussing on the living arrangements of Chinese-Canadian seniors. Data for Canadians aged 55 and older from the 1996 individual census Public Use Microdata File (PUMF) (n=159,361), General Social Survey Cycle 11 (GSS11) (n=12,756) and National Population Health Survey (NPHS) (n=13,363) were used in this analysis. Logistic regressions using the PUMF and GSS11 data suggest that while personal income and characteristics of immigrants play important roles in encouraging living alone among older Canadians, their effects do not nullify the role of culture among Chinese- Canadian seniors. Importantly, these effects vary substantially by gender and age. These findings underscore the heterogeneity of Canadian seniors, which is often overlooked in the design and delivery of services to this segment of the population.

  17. Student Enrolment and Faculty Recruitment in Ontario: The Double Cohort, the Baby Boom Echo, and the Aging of University Faculty
    Byron G. Spencer
  18. The recent restructuring of the Ontario secondary school system means that two graduating classes the so-called "double cohort" will compete for admission to the universities in the fall of 2003. Unless admission standards are raised to restrict enrolment, the sheer numbers involved will place extraordinary demands on the system for half a decade. The demands will be difficult to accommodate, not least because more than half of current faculty are over the age of 50, and most will retire in this decade. Working with the latest available numbers, this paper provides projections to show the impact that the double cohort will have on student numbers, faculty requirements, and the need to recruit new faculty.

  19. Gender Differences in the Influence of Economic, Lifestyle, and Psychosocial Factors on Later-life Health
    Steven G. Prus and Ellen Gee
  20. This paper examines the differential impact of social forces on the health of men and women aged 65+ using data from the 1994-1995 National Population Health Survey. Multiple regression analysis is used to estimate gender differences in the influence of socio-economic, lifestyle, and psychosocial factors on both self-rated health and overall functional health. Some key findings are: 1) the relationship between income and health is significant for older women, but not for older men, while the opposite occurs for education; 2) having an acceptable body weight is positively associated with health for elderly women only; and 3) stress-related factors are generally much stronger determinants of health for older women. These findings shed light on the processes of healthy aging for men and women.

  21. Asking Consumption Questions in General Purpose Surveys
    Martin Browning, Thomas F. Crossley, Guglielmo Weber
  22. In many research areas it is desirable to have information on household total expenditure (‘consumption’). We draw evidence from several sources on the usefulness of recall consumption questions. We conclude that valid information can be collected by adding specific recall questions to general purpose surveys, and provide recommendations on how to do so.

  23. A Longitudinal Study of the Residential Mobility of the Elderly in Canada
    Yuri Ostrovsky
  24. An intensely debated question in the lifecycle literature is whether housing wealth is viewed by households as a financial asset that will be used to support general consumption after retirement. This paper uses the newly available longitudinal Canadian Survey of Labour and Income Dynamics (SLID) to investigate the factors influencing elderly households' residential mobility choices. A dynamic non-linear panel (longitudinal) data dynamic model is employed. I use the Bover-Arellano estimator (Chamberlain's class of estimators), based on reduced form predictions of the latent dependent variable. The residential mobility of the elderly appears to be affected mostly by moving costs, which are different for owners and non-owners.

  25. Health Care in Rural Communities: Exploring the Development of Informal and Voluntary Care
    Mark W. Skinner and Mark W. Rosenberg
  26. Nation-state restructuring has resulted in significant political, economic and social change in rural communities. One manifestation of this transformation has been the changing nature of local governance, characterised by the re-working of central-local relations and public- private responsibilities, such that local informal and voluntary sectors now play an active and direct role in the organisation and delivery of health care services.

    This paper investigates the relationship between the changing nature of local governance and the provision of health care services, and places it within the context of rural communities and population aging in Canada. In particular, it considers the ascendancy of informal and voluntary sectors with respect to homecare in rural Ontario, and features an analysis of data from the National Population Health Survey and the National Survey of Giving, Volunteering and Participating, representing user (demand) and provider (supply) perspectives respectively.

    The results provide a cross-section of informal and voluntary home care in the late 1990s, which indicates that informal and voluntary sectors are major players in the local organisation and delivery of health care services in rural communities. This suggests that the current state of health care provision in rural communities of Ontario is affected very much by the changing nature of local governance associated with restructuring. The 'snap-shot' of health care in rural communities presented in this paper highlights the need to examine further the relationship between governance and health care services at the local level. It also points to the need for more detailed data sets that integrate health, informal and voluntary care data at meaningful geographical and administrative scales to reflect clearly rural communities in Canada.

  27. Does Cognitive Status Modify the Relationship Between Education and Mortality? Evidence from the Canadian Study of Health and Aging
    Jamie C. Brehaut, Parminder Raina, and Joan Lindsay
  28. Background: There is compelling evidence of an inverse relationship between level of education and increased mortality. In contrast to this, one study showed that among subjects with Alzheimer's Disease, those with high education are more than twice as likely to die earlier; however, this result has proven difficult to replicate. We examine the relationship between education and mortality by cognitive status using a large, nationally representative sample of elderly.

    Methods: A representative sample of 10,263 people aged 65 or over from the 10 Canadian provinces participated in the Canadian Study of Health and Aging in 1991. Information about age, gender, education, and an initial screening for cognitive impairment were collected; those who screened positive for cognitive impairment were referred for a complete clinical and neuropsychological examination, from which cognitive status and clinical severity of dementia were assessed. Vital status and date of death were collected at follow-up in 1996. The analysis was conducted using survival analysis.

    Findings: Cognitive status modifies the relationship between education and mortality. For those with no cognitive impairment, an inverse relationship between education and mortality exists. Elderly with cognitive impairment but no dementia, or those with dementia, are more likely to die early than the cognitively normal at baseline, but no relationship exists between education and mortality. Interpretation. These findings do not support previous work that showed a higher risk of mortality among highly educated dementia subjects.

  29. Agreement between Self-Reported and Routinely Collected Health Care Utilisation Data among Seniors
    Parminder Raina, Vicki Torrance-Rynard, Micheline Wong, and Christel Woodward
  30. Objective: To examine the agreement between self-reported and routinely collected administrative health care utilisation data, and the factors associated with agreement between these two data sources. Data Sources/Study Setting: A representative sample of seniors living in an Ontario county within Canada was identified using the Ontario Ministry of Health’s Registered Persons Data Base in 1992. Health professional billing information and hospitalisation data were obtained from the Ontario Ministry of Health and Long-Term Care (OMH) and the Ontario Health Insurance Plan (OHIP).

    Principal Findings: Substantial to almost perfect agreement was found for the contact utilisation measures, while agreement on volume utilisation measures varied from poor to almost perfect. In surveys, seniors overreported contact with general practitioner and physiotherapists or chiropractors, and underreported contact with other medical specialists. Seniors also underreported the number of contacts with general practitioners and other medical specialists. The odds of agreement decreased if respondents were male, aged 75 years and older, had incomes of less than $25,000, had poor/fair/good self-assessed health status, or had two or more chronic conditions.

    Conclusion: The findings of this study indicate that there are substantial discrepancies between self-reported and administrative data among older adults. Researchers seeking to examine health care use among older adults need to consider these discrepancies in the interpretation of their results. Failure to recognize these discrepancies between survey and administrative data among older adults may lead to the establishment of inappropriate health care policies.

  31. Age, Retirement and Expenditure Patterns: An Econometric Study of Older Canadian Households
    Frank T. Denton, Dean C. Mountain, Byron G. Spencer
  32. The paper explores the allocation of consumption expenditure by the older population among different categories of goods and services, and how expenditure patterns change with age within that population. Of particular interest is whether observed differences between pre-retirement and post-retirement patterns are a consequence of changes in "tastes" or reductions in income. An adapted form of the Deaton and Muellbauer Almost Ideal Demand System is estimated with data from six Family Expenditure Surveys and used to investigate that question. The findings suggest that observed changes in budget allocations are most closely related to reductions in income.

  33. Understanding the Relationship between Income Status and the Restrictions in Instrumental Activities of Daily Living among Disabled Older Adults
    Parminder Raina, Micheline Wong
  34. The purpose of this study was to examine the restrictions in instrumental activities of daily living (IADL) among older disabled Canadian adults according to their income status, as well as describe the relationships between income, severity of disability and functional independence. Disabled individuals aged 55 years and older were identified from the 1986 and 1991 Health and Activity Limitation Surveys. The overall unweighted sample size for each survey was 132,337 in 1986 and 91,355 in 1991.

    Between 10.3% (men aged 65 years and older in 1986) and 23.2% (women aged 65 years and older in 1991) were classified as having low income. In both survey years and in both age groups, more females were categorized as low income compared with males. Low income respondents aged 55-64 years old were also generally less likely to be categorized as mildly disabled and more likely to be categorized as severely disabled compared with those classified as having a high income (p’s < 0.003). In both 1986 and 1991, women in both age groups, whether high or low income, generally reported more IADL restrictions than men. The majority of respondents in both the high and low-income groups reported having zero IADL restrictions (41.0% and 40.6% respectively). Over 90% of both high and low income respondents indicated that they either made all or most decisions regarding their everyday activities.

    Our model suggests that income status negatively influences severity of disability, and in turn, severity of disability negatively influences functional independence, as defined by the number of IADL restrictions and perceived decision making control. Disabled low income seniors and senior women are vulnerable groups within the elderly population. In an aging population, strategies of the health care system and other sectors are needed to counter low-income status and improve functional independence so that older disabled Canadian adults can improve and maintain their health and independence.

  35. Location of Adult Children as an Attraction for Black and White Elderly Return and Onward Migrants in the United States: Application of a Three-level Nested Logit Model with Census Data
    Kao-Lee Liaw, William H. Frey
  36. This paper assesses the influence of the location of adult children on the 1985-90 interstate migration of black and white elderly "non-natives" (i.e. those whose state of residence in 1985 was different from their state of birth) in the United States, based on the application of a three-level nested logit model with 1990 census data. The model accounts for (1) the choice between departing and staying put, (2) the choice between return and onward migration, and (3) the choice of a specific destination.

    The main findings are as follows. First, elderly non-natives were strongly attracted by the location of their adult children when they made their migration decisions at all levels of the choice framework, and this attraction was stronger for the widowed than for those of other marital statuses. This finding can be taken as empirical support for Eugene Litwak's theory of the modified extended family. Second, in the return/onward and destination choice processes, the attraction of the location of adult children was found to be stronger for whites than for blacks. This finding is consistent with the finding of Hogan et al (1993) that whites had stronger intergenerational connections than did blacks.

  37. Changing Income Inequality and Immigration in Canada 1980-1995
    Eric G. Moore, Michael A. Pacey
  38. While there is a general consensus that income inequality has increased in most developed countries over the last two decades, the analytical focus has been at the national scale. However, these increases in inequality have not been uniform across different segments of society, either in terms of social group or geographic region. In particular, the high levels of immigration to metropolitan Canada have contributed to growing inequality.

    Using micro-level data on household income from the 1981,1986,1991 and 1996 censuses, this paper identifies the role of immigration and its differential impact on metropolitan and non-metropolitan areas. The impacts accelerated during the first half of the 1990s when immigration remained high yet the economy slowed. The evidence suggests that the overall impact of immigration is a relatively short-run phenomenon as recent immigrants take time to adjust to the labour market. If recent immigrants are excluded, inequality is still increasing, but at a slower rate, especially in the largest metropolitan areas.

  39. The Dynamics of Food Deprivation and Overall Health: Evidence from the Canadian National Population Health Survey
    Logan McLeod, Michael R. Veall
  40. The paper explores whether the responses to food deprivation questions on the longitudinal Canadian National Population Health Survey help explain the links between socio-economic status and health. Transitions in food deprivation status are correlated with changes in health status. While health transitions are correlated with changes in food deprivation status, there is little evidence that change in food deprivation status leads changes in health status but some evidence that change in health status leads change in food deprivation status.

  41. Quebec's Lackluster Performance in Interprovincial Migration and Immigration: How, Why, and What Can Be Done?
    Kao-Lee Liaw, Lei Xu, and Mingzhu Qi
  42. In light of the persistent trend in Quebec's diminishing share of the Canadian population (from 28.9% in 1966 to 24.0% in 2000), this paper examines Quebec's roles in the life-time interprovincial migration of the Canada-born elderly, the initial destination choices of landed immigrants, and the post-landing relocations of immigrants.

    From the 1996 census data, we found that Quebec ended up with an overall net loss of 4.9% of Canada-born elderly lifetime migrants, which was highly selective of non-Francophones and moderately selective of those with better education and higher income. The selective net loss was rooted in the cultural disharmony between Quebec and the rest of Canada as well as Quebec's relative shortage of good economic opportunities.

    From the micro data on the landed immigrants, we found that Quebec attracted only 16.6% of Canada's 1980-99 landed immigrants, and that its share was highly selective by immigration class, language ability, and place of birth. Although the Quebec government got the exclusive responsibility for the selection of its independent immigrants since 1991, we have identified serious internal and external obstacles and constraints that prevent Quebec from getting enough immigrants to match its population share in the foreseeable future.

    From the 1980-95 data of linked records of landing and tax-filing, we found that the post-landing relocations of immigrants resulted in Quebec's net loss of 13% in three years after landing, and that the net loss was also highly selective by immigration class, language ability, and place of origin, but fortunately did not result in a larger net loss of the best educated immigrants. Some reasons for the selective losses were the non-French-speakers' difficulty in adjusting to the French milieu, the business immigrants' use of Quebec as a stepping stone to the rest of Canada, and the desire of most immigrants to have their children educated in English schools.

    In our opinion, the fundamental way to increase Quebec's share of new immigrants and to reduce its net losses of Canada-born and foreign-born migrants is to soften its restrictive language regulations and to help Quebeckers cultivate positive views on immigration. Adoption of foreign children, recruitment of third-world students and researchers in the universities and research institutes in French-speaking countries, and invitation of non-Francophone students from the rest of Canada to study in the French schools of Quebec are some viable options that can help reduce Quebec's loss in population share in the long-run without threatening its Frenchness.

  43. Out-of-Pocket Prescription Drug Expenditures and Public Prescription Drug Programs
    Sule Alan, Thomas F. Crossley, Paul Grootendorst, and Michael R. Veall
  44. Abstract: Canadian household prescription drug expenditures are studied using different years of the Statistics Canada Family Expenditure Survey. Master files are used, expanding the number of available years and permitting provincial rather than regional identifiers. Nonparametric Engel curves are estimated. Difference-in-difference mean and 80th percentile regressions examine budget shares by low-income and high-income households before and after the introduction of provincial prescription drug programs. The evidence is consistent with the view that unlike senior prescription drug subsidies, nonsenior prescription drug subsidies are probably more redistributive than an equal-cost proportional income transfer.

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Last revised: Dec 23, 2002.