Traditional approaches to health human resources planning emphasize the role of demographic change on the needs for health human resources. Conceptual frameworks have been presented that recognize the limited role of demographic change and the broader determinants of health human resource requirements. Nevertheless, practical applications of health human resources planning continue to base plans on the size and demographic mix of the population applied to simple population-provider or population-utilization ratios. In this paper an analytical framework is developed based on the production of health care services and the multiple determinants of health human resource requirements. In this framework attention is focused on estimating the ‘flow’ of services required to meet the needs of the population that is then translated into the required ‘stock’ of providers to deliver this ‘flow’ of services. The requirements for human resources in the future is shown to depend on four elements: the size and demographic mix of the population (demography), the levels of risks to health and morbidity in the population (epidemiology), the services deemed appropriate to address the levels of risks to health and morbidity (standards of care), and the rate of service delivery by providers (productivity). Application of the framework is illustrated using hypothetical scenarios.
Beyond income, wealth is an important measure of economic well-being, because while income captures the current state of inequality, wealth has the potential for examining accumulated and historically structured inequality. This paper documents the extent of gender inequality in wealth for Canadian women and men aged 45 and older. The analysis uses data from the 1999 Canadian Survey of Financial Security, a large nationally representative survey of household wealth in Canada. Wealth is measured by total net worth as measured by total assets minus debt. We test two general hypotheses to account for gender differences in wealth. The differential exposure hypothesis suggest that women report less wealth accumulation because of their reduced access to the material and social conditions of life that foster economic security. The differential vulnerability hypothesis suggests that women report lower levels of wealth because they receive differential returns to material and social conditions of their lives. Support is found for both hypotheses. Much of the gender differences in wealth can be explained by the gendering of work and family roles that restricts women’s ability to build up assets over the life course. But beyond this, there are significant gender interaction effects that indicate that women are further penalized by their returns to participation in family life, their health and where they live. When women do work, net of other factors, they are better able to accumulate wealth than their male counterparts.
The drop in income poverty among the elderly in Canada over the last generation has been well-documented. In this paper, I extend the calculation of head-count measures of poverty to all currently available microdata, spanning the years 1973 to 2003. I then generate consumption poverty measures spanning 1969 to 2004 and compare to the income poverty results. For both income and consumption, I implement a relative poverty measure that uses the wellbeing of working age families as a benchmark for the elderly. I find that income poverty among the elderly decreases sharply through the 1970s and 1980s by all measures. Since the mid-1990s, relative measures of income poverty have increased substantially, reflecting increasing income among the working age and better- off elderly more than an absolute decrease among lower-income elderly. For consumption, a similar downward trend from the 1970s to the 1990s is evident, although the level of consumption poverty among the elderly is very sensitive to the treatment of housing flows and durables. Since the 1980s, a sharp spike in income poverty has emerged between the ages of 55 and 64. Interestingly, no similar spike is found in the consumption data, which may suggest that many families successfully smooth their consumption over a spell of low-income in this age range.
Using the 2001 Public Use Microdata Files from Statistics Canada, this paper analyses fixed interval return (migrations returning an individual to a previous place of residence) and onward (migrations to a subsequent destination) migration among Canada’s older population (aged 60 and over) over the 1996-2000-2001 period. The article examines the incidence, composition, spatial patterning, and determinants of these chronic migrations. Analysis reveals a migration system that is largely complementary to that observed within the broader population, although onward migration is relatively unimportant for this group, and the motivations and characteristics vary by age group amongst older migrants.
This paper shows that, beyond the institutional stability of Social Security, changes in the private sector as well as the emergence of a new financial paradigm have transformed both the U.S. pension system and the political debate about its future. Although no major reform of Social Security has been enacted since 1983, this system changes slowly because of the decline of defined-benefit schemes and the multiplication of tax-sponsored personal savings accounts in the private sector. Related to a financial and individualistic logic, this phenomenon serves as an explicit model for conservative actors seeking to privatize Social Security. So far, these efforts have failed. This text explains why before exploring the comparative strengths and the limitations of the existing U.S. pension system.
We study the effects of liquidity constraints and start-up costs on the relationship between wealth and the fraction of entrepreneurs in an economy. We develop a dynamic occupational choice model that yields predictions that can be tested on cross-sectional data with exogenous variation in liquidity constraints (e.g. access to credit) and start-up costs. We use three highly comparable micro datasets (SHARE, ELSA and HRS) focusing on the population age 50+ in 9 countries. These countries have very different levels of start-up costs and potential liquidity constraints. Reduced form results support our theoretical predictions. While higher liquidity constraints yield a steeper wealth profile for the fraction of workers in entrepreneurship, startup costs flatten this relationship by depressing the marginal value of being an entrepreneur as a function of wealth. Countries with high start-up costs such as Italy, Spain and France have flatter wealth gradients.
We look at the effect of the 2000 repeal of the earnings test above the normal retirement age on retirement expectations of workers in the Health and Retirement Study, aged 51 to 61 in 1992. For men, we find that those whose marginal wage rate increased when the earnings test was repealed, had the largest increase in the probability to work full-time past normal retirement age. We do not find significant evidence of effects of the repeal of the earnings test on the probability to work past age 62 or the expected claiming age. On the other hand, for those reaching the normal retirement age, deviations between the age at which Social Security benefits are actually claimed and the previously reported expected age are more negative in 2000 than in 1998. Since our calculations show that the tax introduced by the earnings test was small when accounting for actuarial benefit adjustments and differential mortality, our results suggest that although male workers form expectations in a way consistent with forward-looking behavior, they misperceive the complicated rules of the earnings test. Results for females suggest similar patterns but estimates are imprecise.
In this paper we investigate the size of health differences that exist among men in England and the United States and how those differences vary by Socio Economic Status (SES) in both countries. Across a wide variety of diagnosed diseases, average health status among mature men is much worse in America compared to England. A steep negative health gradient exists for men in both countries. This social health gradient is present whether education, income, or financial wealth is used as the marker of SES and, in addition, appears to be steeper in the United States. These conclusions are maintained even after controlling for a standard set of behavioral risk factors such as smoking, drinking, and obesity and are equally true using either biological measures of disease or individual self reports. In contrast to these disease based measures of health, the health of American men appears to be superior to the health of English men when self reported subjective general health status is used as the measure of health status. This apparent contradiction does not result from differences in co morbidity, emotional health, or ability to function, all of which still point to mature American men being less healthy than their English counterparts. Finally, we present preliminary data that indicate that feedbacks from new health events to household income are also one of the reasons that underlie the strength of the income gradient in health.
We describe the trajectory of pension reform in the United Kingdom, which has focussed on keeping the cost of public pension programmes down during a period of steady population ageing whilst attempting to maintain an adequate minimum level of income security for low income households in retirement. Instruments for achieving these aims have been to target public benefits on low income households, permitting individuals to opt out of the second tier of the public programme into private retirement accounts, and the use of tax incentives to encourage additional private retirement saving. Frequent reforms to the pension programme raise the question of whether households can make reasonable private retirement saving provision in the light of growing complexity and potential shortcomings in individual decision-making. This paper sheds some light on these issues.
Australia’s retirement income system has several distinctive features – most notably a policy of government mandated private saving and a means-tested Age Pension – which have gained increasing international attention. This paper provides an overview of the institutional features of the retirement income system in Australia, including details of the development and operation of the policy of forced retirement saving. The role of the different tiers of system in accounting for the income of the current cohort of seniors is examined using the Australian Bureau of Statistics Household Expenditure Survey. The economic position of adjacent, younger cohorts is also considered. The final section canvasses a selection of reform proposals emerging from the public debate over the future of Australia’s retirement income system.
Even though universal health care is one of the fundamental pillars of Canadian society, the rising cost of all services has resulted in the relocation and redistribution of funding and services between rural and urban areas. While most econometric analyses of health service use in Canada include broad controls by province and rural/urban status, there has been relatively little econometric work that has focused specifically on geographical variation in health service use. Using the 2002-03 wave of the Canadian Community Health Survey, we examine the determinants of a range of health services use by older Canadians across different types of urban and rural areas of residence. The regression analysis suggests two general conclusions: 1) other things equal, health service use is lower among older residents of rural areas in terms of visits to a GP, to a specialist and to a dentist compared to residents of urban core CMA/CAs, but there are no significant differences in hospital nights; and 2) these results are surprisingly robust across a range of specifications that control variously for demographic characteristics, socio-economic status, private health insurance, and physical health. However, the magnitude of the estimated differences is quantitatively not very large. In addition, the self-reported incidence of unmet healthcare needs overall shows no systematic variation across rural and urban areas.
This paper provides evidence of on-the-job training among older workers in Canada. It also examines the effect of age associated with on-the-job training. Statistics Canada’s Workplace and Employee Survey (WES) 2001 data, linking employee responses to workplace (i.e. employer) responses are used. Three quarters of workers are categorized as middle aged, with about one in ten being younger and one in five considered to be older. Only 32% of Canadian workers received on-the-job training in the year preceding this survey. When separating workers into the three age categories, 37%, 34%, and 24% of younger, middle-aged, and older workers, respectively, received on-the-job training in that year. Logistic regression analysis results showed that, controlling for workplace, job and individual factors, as compared to middle-aged workers, older workers are significantly less likely to receive on-the-job training. The lack of on-the-job training for older workers should be a concern for policy makers at a time when labour shortages are being predicted. Older workers are healthier than ever and the provision of on-the-job training should be encouraged to retain older workers in the labour market in Canada.
By all measures the private pension system in Canada is in difficulty. One estimate suggests that at the end of 2005 there were significant funding shortfalls in about three quarters of the traditional defined benefit pension plans that fall under federal jurisdiction in Canada. In order to discuss how vulnerable the current system is, to identify possible directions of reform, and to consider how to implement them, the conference on “Private Pensions and Income Security in Old Age: An Uncertain Future” brought together researchers, those who design and manage pension plans, and those responsible for pension policy, both from Canada and abroad. It was organized by the SEDAP Research Program and held in Hamilton, Ontario, in November 2006. This paper summarizes the presentations that were given in 10 conference sessions, covering issues such as pension regulations, poverty and income security in old age, policy options, reform obstacles, and international perspectives. Many of the conference presentations, including tables and graphs, are available on SEDAP’s website: http://socserv.mcmaster.ca/sedap/ConfPresNov2006.htm
This paper tests two competing hypotheses on the relationship between age, SES, and health inequality at the cohort/population level. The accumulation hypothesis predicts that levels of SES- based health inequality and consequently overall health inequality within a cohort progressively increase as it ages. The divergence-convergence hypothesis predicts that these inequalities increase only up to early-old age then decrease. Data from a Canadian national health survey are used in this study, and are adjusted for SES-biases in mortality. Bootstrap methods are employed to assess the statistical precision and significance of the results. The Gini coefficient is used to estimate change in the overall level of health inequality with age and the Concentration coefficient estimates the contribution of SES- based health inequalities to this change. Health is measured using the Health Utilities Index and income and education provide the measure of SES.
First, the findings show that the Gini coefficient progressively increases from 0.048 (95% CI: 0.045, 0.051) at ages 15-29 to 0.147 (95% CI: 0.131, 0.163) at ages 80+. Second, the data reveal that health inequalities between SES groups (Concentration coefficients for income and education) tend to follow a similar pattern of divergence. Together these findings provide support for the accumulation hypothesis. A notable implication of the study's findings is that the level of health inequality increases when compensating for age-specific socio- economic differences in mortality. These selective effects of mortality should be considered in future research on health inequalities and the life course.
This study examines ethnic based differences in economic and health status. We combine existing literature with our analysis of data from the Canadian Census and National Population Health Survey. If a given sub-topic is well researched, we summarize the findings; if, on the other hand, less is known, we present data placing them in the context of whatever literature does exist. Our findings are consistent with existing literature on ethnic inequalities in Canada. Recent immigrants with a mother tongue other than English or French are among the most economically disadvantaged in Canadian society, though the results vary depending on gender and ethnic background. In fact economic inequality according to type of occupation can be attributed to gender rather than ethnicity; that is, the Canadian labour force continues to be more gender- than ethnically-differentiated. Yet recent immigrants, especially from Asia, are advantaged in health outcomes compared to Canadian-born persons – the “healthy immigrant” effect. Interestingly they are less likely to report having a physical check-up and, for women (especially Asian-born women), a mammogram within the last year compared to their Canadian-born counterparts. Given the significance of both gender and ethnicity as predictors of well-being, future research should examine the intersection between the two identity markers and their relationship to social inequality.
The relationship between home ownership of Dutch elderly households and age is strongly negative. Other studies suggest that this age gradient should be attributed to a cohort effect. In this paper we investigate where those cohort effects come from. We also observe that mortgage ownership among elderly home-owners increased considerably during the nineties. Using panel data we estimate models explaining home and mortgage ownership by age, cohort, and time effects, as well as other factors. Cohort and time effects are modelled explicitly using macro economic and housing market related variables. We find that the level of GDP per capita when the household head was young is the main factor explaining generation effects in home ownership among the elderly. After accounting for cohort effects it also appears that home ownership decreases slightly with age. Mortgage ownership among elderly home owners rose considerably during the nineties due to house price increases and due to financial innovation in the mortgage market. Cohort effects are also important. A supplementary analysis suggests that those cohort effects are due to the fact that the accidental bequest motive is becoming less important.
This paper investigates the source of the gap in the relative wealth position of immigrant households residing in Australia, Germany and the United States. Our results indicate that in Germany and the United States wealth differentials are largely the result of disparity in the educational attainment and demographic composition of the native and immigrant populations, while income differentials are relatively unimportant in understanding the nativity wealth gap. In contrast, the relatively small wealth gap between Australian- and foreign-born households exists because immigrants to Australia do not translate their relative educational and demographic advantage into a wealth advantage. On balance, our results point to substantial cross-national disparity in the economic well-being of immigrant and native families, which is largely consistent with domestic labor markets and the selection policies used to shape the nature of the immigration flow.
While the fraction of obese people is not as large in Europe as in the United States, obesity is becoming an important issue in Europe as well. Using comparable data from the Survey of Health, Aging and Retirement in Europe (SHARE) and the Health and Retirement Study in the U.S. (HRS), we analyze the correlates of obesity in the population ages 50 and above, focusing on measures of energy intake and expenditure as well as socio-economic status. Our main results are as follows: 1) Obesity rates differ substantially on both sides of the Atlantic and across European countries, with most of the difference coming from the right tail of the weight distribution. 2) Part of the difference in obesity prevalence between the U.S. and Europe is explained by a higher fraction of food eaten away from home and notably lower time devoted to cooking in the U.S. 3) Sedentary lifestyle or a lack of vigorous and moderate physical activity may also explain a substantial share of the cross-country differences. 4) Differential SES patterns of energy intake and expenditure across countries cannot fully account for the observed cross-country variation in the SES gradient in obesity.
About 6% of seniors in Canada have family incomes below the Low-Income Measure. (The Low-Income Measure is 50% of the median family income, adjusted for family size, and is a commonly used, if arbitrary, operational definition of relative poverty.) This is a low rate by international standards, in sharp contrast to the high rate in Canada about 35 years ago. It is lower than the comparable rates for the general Canadian population or for families with children and more Canadians leave below-LIM status during their retirement years than enter it. Canadian income tax data show that the remaining 6% are disproportionately immigrant, female, currently unmarried and supporting dependent children (possibly grandchildren). Age does not appear to be of great importance.
As countries face the challenges posed by rising numbers of older persons, the need to reassess their respective policies to address transport needs in aging societies is increasingly recognized in relation to health and sustainability goals. This paper proposes the examination of six interrelated policy areas affecting elderly mobility in a country or administrative region. A general survey of policy developments in each of these areas could improve current strategies and existing processes in the planning and implementation of mobility services that will be responsive to both elderly and the general population now and in the future. These include: 1) general transport policy framework; 2) travel mode preference; 3) alternative transport infrastructure stock and investments; 4) housing-land-use-transportation linkage; 5) research and technology applications that improve travel mode and environment; and 6) institutional and legal reforms. These policy areas are discussed and given concrete elucidation in the case of Ontario, Canada. Reflections and recommendations for further research and policy action deemed critical in the case region are highlighted.
Is the integration of occupational pension regulations across the Canadian provinces feasible? In this paper, we assess the proposal for harmonization made by the Canadian Association of Pension Supervisory Authorities (CAPSA) by comparing it to the EU’s successful integration of member states’ pension regulations. We argue that CAPSA’s initiative failed both because regulatory diversity was defined as a fundamental problem and because the regulations that serve social policy goals were not protected from integration. We suggest that occupational pension integration in Canada would be feasible if provincial governments largely excluded rules on benefits and relied primarily on the mutual recognition of regulations.
We study the psychosocial determinants of health, and their impact on social inequalities in health in France.
We use a unique general population survey to assess the respective impact on selfassessed health status of subjective perceptions of social capital controlling for standard socio-demographic factors (occupation, income, education, age and gender). The survey is unique for two reasons: First, we use a variety of measures to describe self-perceived social capital (trust and civic engagement, social support, sense of control, and selfesteem). Second, we can link these measures of social capital to a wealth of descriptors of health status and behaviours.
We find empirical support for the link between the subjective perception of social capital and health. Sense of control at work is the most important determinant of health status. Other important ones are civic engagement and social support. To a lesser extent, sense of being lower in the social hierarchy is associated with poorer health status. On the contrary, relative deprivation does not affect health in our survey. Since access to social capital is not equally distributed in the population, these findings suggest that psychosocial factors can explain a substantial part of social inequalities in health in France.
An abundance of literature links socio-economic status to health and health care in Canada and other countries. Recent anecdotal evidence indicates that Canadians believe their access to health care is diminishing over time. This study provides a brief description of utilization patterns in health-care services provided under public health insurance (physicians, specialists and hospitals) in Canada between 1978 and 2003. The relationships between socio-economic status (SES) and utilization, controlling for demographic characteristics are examined to investigate whether changes in the equity of utilization have occurred over time. Results indicate that SES inequities in utilization are apparent in publicly insured services, appearing to be more relevant in initial contact with the system rather than in the number of visits. Specialist’s services are particularly problematic and becoming more so over time.
The government of Canada is committed to closing the health status gap between First Nation’s (FN) and non-First Nation’s peoples in Canada. The government of Canada is also committed to evidenced-based policy making and accountability. To provide evidence of effective programming, it must monitor the health and well-being of its First Nations and Inuit populations over time. Evidence on the health status of FN peoples living on-reserve is difficult to obtain due to limited data sources. However, the Aboriginal Peoples Survey (APS) provides information on the health status of on-reserve and off-reserve FN peoples. Important determinants of health such as socio-economic status (SES), health-care utilization and health behaviours will also be documented, as many of the government programmes offered aim to improve health status by affecting the behavioural determinants of health.
Aggregate rates of productivity growth are among the most closely watched indicators of economic performance. They are also among the most difficult to measure accurately. This paper explores the sensitivity of such rates to random measurement error using a simple generic model. The model allows for errors in the input and output components of the productivity ratio, with different variances, and for serial and cross correlation of the errors. The effects of the errors are considered from the point of view of growth rates themselves, changes in growth rates, and comparisons between rates in different countries.
Using a multinomial logit model, this paper explains the initial destination choices of skilled-worker immigrants from four South Asian countries (India, Pakistan, Bangladesh, and Sri Lanka) who landed in Canada in 1992-2001, based on the micro data of Citizenship and Immigration Canada. We found that their choice pattern, which is characterized by extremely strong concentration in Ontario, was strongly affected by the attractions of (1) co-ethnic communities and (2) long-term income opportunities represented by earned income per capita. The temporal pattern of their choices was subject to the lagged effects of the fluctuations in the spatial pattern of employment opportunities in an economically sensible but relatively mild way. The enhancement of Quebec’s attraction by the Canada/Quebec agreement on immigration dissipated within only a few years.
Based on the longitudinal Immigration Data Base, this research found that the post-landing interprovincial migration of newly landed immigrants led to a further concentration in Ontario and British Columbia. Underlying this pattern was the fact that each of these two provinces had a relatively strong economy, large immigrant communities, and a major international airport. This further concentration of relocating immigrants is problematic in the sense that it contributed to the weakening of the political powers of the economically weak provinces. With respect to immigration classes, the interprovincial net transfer was much stronger for those in the investor, entrepreneur, and refugee classes than for those in the family and assisted relative classes. The research also suggested that the deconcentration and widespread dispersal in the 1995-2000 interstate migration of the immigrants in the U.S. can not serve as a harbinger for a general reversal in the interprovincial migration of immigrants in Canada.
Based on the tabulations of the IMDB, I characterized, explained and compared the 1991-1996 and 1996-2001 inter-CMA migration of the immigrants in Canada. The spatial and temporal patterns were consistent with the neoclassical economic theory and the ethnic enclave theory. In making their decisions on departure and destination choices, the immigrants (both the 1991 landing cohort and 1996 cohort) were responsive to income and employment incentives, as well as the retaining and attracting powers of ethnic communities. This research also discovered an interesting temporal pattern -- while the inter-CMA migration of immigrants accentuated the over representation of the immigrants in Toronto and Vancouver in the 91-96 period, the rise of the “secondary” CMAs led to a spatial dispersal of the immigrants in the 96-01 period. This “new” finding supplements the existing literature on internal migration of Canadian immigrants, which discovered little evidence of an increased dispersion of immigrants over time.
Based on the primary micro data files of the 2001 Canadian census, I investigated the 1996-2001 internal migration patterns of the 2nd generation, in comparison to those of the 1st, 1.5, and 3rd+ generations. In the descriptive analysis, I found that the overall out-migration rate increased monotonically with an increase in generation status. However, with the exception of Toronto, Vancouver and Calgary, the CMA specific out-migration rate generally decreased with an increase in generation status. In terms of in-migration, Toronto, Vancouver, and Calgary were the predominant destinations for all generations. In the multivariate analysis, I found that the different generations were subject to the effects of the same set of explanatory factors -- labor market factors, ethnic similarity factor, and personal factors. Compared to the first generation immigrants, the second generation was less dependent on ethnic communities and more sensitive to the changing spatial economy of the CMA system.
This paper analyses the labour market transitions of older men and women using data from the British Household Panel Survey (BHPS). I find large peaks in exit rates out of employment at ages 60 (women) and 65 (both sexes) which occur in the exact birthday month. This suggests that pension schemes have strong incentive effects. Discrete-time hazard regression analysis shows that benefits and health status are the two most important determinants of retirement, with effects that are larger than found in previous studies for British and US men. When modelling unobserved heterogeneity I find that women are twice as likely as men to be `movers' between work and non-work.
This paper analyses how spouses in older couples react to `shocks' or `surprises' in their partner's labour income using data from the British Household Panel Survey, 1991-2004. Wives' labour supply proves to be much more sensitive to shocks than husbands'. After a divorce or separation, wives reduce their labour supply while the effect on husbands' labour supply is positive or not statistically significant. If a wife becomes unemployed, it does not affect her husband's labour supply while wives whose husband becomes unemployed reduce their labour supply, too. A decline in husband's health causes the wife to reduce her working hours while husbands tend to increase their labour supply when facing a decline in wife's health. Partner's death does not have statistically significant labour supply effects. Negative income shocks due to other reasons (such as choice) tend to reduce partner's labour supply and vice versa, but only slightly.
We examine retired Canadians’ subjective survey reports of satisfaction with finances,and with life, relative to the period before retirement.
We review the theoretical literature on defined benefit (DB) pension plans, particularly focusing on the issue of plan underfunding and benefit guarantee insurance schemes. The literature shows that underfunding can, under reasonable assumptions, be an equilibrium outcome even in the absence of benefit insurance. The introduction of benefit guarantee funds was a reaction to the problem of underfunding, and we summarize the ensuing standard problems of moral hazard and adverse selection. We briefly discuss the small empirical research on the subject and propose directions for future research.
This paper examines how the use of ‘authorized-generics’ (AGs) influences Canadian prescription drug prices. An authorized-generic is the actual brand name drug product, manufactured by the brand firm, but sold as a generic by a licensee or subsidiary of the brand, competing with independent generics (IGs), which operate independently from the brand firm. In theory, AGs have offsetting effects on drug prices. On the one hand, AGs compete against IGs and increases in the number of generic competitors should lower prices. On the other hand, the threat of AG entry into a therapeutic market might deter entry by IGs and this would lessen competition. Moreover, brand firms might increase prices of their brand drugs to increase demand for their AG. I find that when AGs are first to enter a drug market, average drug prices drop by about 12%; average prices drop by smaller amounts, the larger the AG share of the generic market. I could not directly assess whether the threat of AG entry into a market might deter entry by IGs. IG executives, however, state that the threat of AG entry has decreased their incentive to challenge ‘marginal’ drug markets. In particular the threat of AG entry has increased from $5m to $10m the threshold market size – the value of brand drug sales in the 10th year that it has been on the market, below which the IG firm will not attempt to enter. IG executives also stated that AGs have seriously reduced IG retained earnings. The reduction in retained earnings has hampered their ability to challenge brand drugs with annual sales well above $10m, but which have particularly high entry costs. Finally, the IG executives claimed that brand firms have attempted to use the threat of AG entry to negotiate agreements with the IG to delay entry (or not enter at all). A comprehensive evaluation of the competitive effects of AGs would need to verify and quantify these costs and compare these to the benefits of AG competition.
Purpose: We present the economic consequences of retiring to caregive when the caregiving is over.
Design and Methods: As part of a larger study of involuntary retirement and its impact on income, in-depth interviews were carried out with 24 caregivers who self-identified as retiring to caregive and who represented different points along the caregiving, retirement, post caregiving continuum.
Results: The major findings that emerged from the analysis were organized into an analytical model according to caregiving-retirement-post caregiving trajectories and indicated: (1) the transition into early retirement took two routes: the first route was precipitated by a crisis and was viewed as temporary; the second route was planned and permanent and was related to deteriorating work conditions but justified by the need to caregive; (2) the caregiving process was wrought with financial distress for those catapulted into retirement by a crisis, while those who planned retirement were able to make ends meet; (3) at the conclusion of the caregiving, the “crisis” caregivers lived in abject poverty while the “planners” reported adequate income; (4) post caregiving survival strategies for those in poverty included attempts at work re-entry, juggling debts, bartering their services and pawning belongings; (5) the caregiving, retirement, post caregiving trajectories were influenced by irreconcilable social norms about women that fluctuated over time.
Implications: Greater understanding of the intersection of caregiver and retirement trajectories over time is necessary for planning financial supports and services for caregivers who retire and for developing social policy that mirrors their lives. Although the caregiving may be over, the continued intervention of professionals is warranted to avoid the distressing economic consequences resulting from retiring to caregive.
Outsiders’ views of American health care – and Canadian views in particular - contains this paradox: ready access to excellent high tech services for those who can pay but unfortunately too expensive for many Americans; in essence, inaccessible abundance. In this paper, I embellish upon this paradox with an initial examination of the rather complicated organization of American health care as viewed by an outside observer. I then highlight the key benefits and drawbacks seen of U.S. health care, grounded in empirical data, and how despite its drawbacks it is being spread to other countries. I conclude with a discussion of the values inherent in the provision of health care – that is, whether it should be viewed as a commodity or as a right of the citizens of a nation.
Although there are several studies of the impact of employment of health professionals in large bureaucratic organizations, there has been significantly less research focused on the structural influence of patients on this relationship. In this paper we present comparative qualitative data gathered on the work experiences of health care professionals in Canadian, U.S. and French hospitals. We elaborate specifically on a typology of structural influence of clients on health care professionals work in hospitals in terms of open and closed units.
The gate-keeping role of primary care has been the most fiercely defended of the health care jurisdictions, but more recently it has become a less attractive form of medical practice. This has created an open market for the expansion of a variety of „substitute providers?. In this paper, I present comparative documentary and interview data from Canada and the U.S. on the changes and composition of the primary health care division of labour. What is revealed from this analysis is that: 1) there is a greater reliance on substitute health labour in the U.S. as evidenced by the greater number of and different kinds of primary care providers; 2) there is also a greater propensity in the U.S. towards specialization even of substitute providers; and 3) in both countries, substitute providers resist that label focusing instead on their own model of practice or niche within the primary care division of labour.
This study examines differences in the prevalence of various forms of cancer among American women identified by both ethnicity and immigrant status. Our focus is on four types of cancer – breast, cervical, ovarian, and uterine – that afflict adult working-age women. We analyse the extent to which the prevalence of these cancers among immigrants changes with years in the United States, after controlling for age and socio- economic influences. The paper also examines the extent to which use of preventative health screening and/or lifestyle behaviors might help to explain any observed differences. Data are drawn from the U.S. National Health Interview Survey (NHIS) over the period 1998 to 2005. We find significant evidence of differences in cancer occurrence among immigrants by ethnicity that change with years spent in the USA, as well as pronounced differences by race. The results confirm that the healthy immigrant effect is present in terms of the prevalence of certain forms of cancer in comparison with both US born whites and with US born ethnic minority groups. The result appears not to be due to differences in health behaviors or in the utilization of general health services.
The O(n-1) bias and O(n-2) MSE of OLS are derived for iid samples. An approach is suggested for handling nonexistent finite sample moments. Bias corrections based on plug-in, weighting, jackknife and pairs bootstrap methods are equal to Op(n-3/2). Sometimes they are effective at lowering bias and MSE, but not always. In simulations, the bootstrap correction removes more bias than the others, but has a higher MSE. A hypothesis test is given for the presence of this bias. The techniques are applied to survey data on food expenditure, and the estimated bias is small and statistically insignificant.
The main purpose of this paper is to study the roles of ethnicity and language acculturation in determining the propensities to make interprovincial migration in Canada in 1976-81, 1981-86, and 1996-2001, based on the micro data of the 1981, 1986 and 2001 censuses. Since these propensities are also subject to the strong effects of other explanatory factors, a multivariate analysis using a binomial logit model is conducted. An important methodological contribution of this paper is the clarification of the interpretational mistakes in the previous multivariate analyses of Trovato and Halli (1983 and 1990) that depended on the widely used log linear models.
Our empirical findings turn out to be substantively more sensible than the earlier findings in the literature. With respect to the less complicated case of non-French minority ethnic groups, the empirical data are found to be mostly supportive of the following two hypotheses. H1: The propensities to make inter- provincial migration are lower for minority ethnic groups than for the mainstream ethnic group. H2: The use of English as home language, which represents an important cultural shift towards the mainstream, increases the inter-provincial migration propensities of minority ethnic groups. The very strong support for these two hypotheses by the Italian ethnic group and the lack of support for H2 by the Jewish ethnic group are highlighted and explained. With respect to the more complicated case of the French ethnic group, our findings are supportive of the following two hypotheses. H3: Among those residing outside Quebec, the propensities to make inter-provincial migration are greater for the French ethnic group than for the mainstream ethnic group. H4: This difference is greater for the French ethnic group that continues to use French as the home language than for the French ethnic group that has shifted the home language to English. It is unfortunate that the support for H4, which could aggravate the spatial polarization of the French and Non-French populations between Quebec and the rest of Canada, became successively stronger towards the late 1990s. Fortunately, this trend was countered by a mild narrowing of the extremely wide gap in the propensities to leave Quebec between the English-speaking British and the French-speaking French.
The objective of this study is to investigate the determinants of mean trip distance traveled by different mode types. The study uses data from the Hamilton CMA in Canada, and multilevel models to investigate demographic aging factors, gender differentials, and neighbourhood attributes on distance traveled. The results of the study validate previous findings regarding the decline in distance traveled as age advances. In addition, it is found that: 1) While this effect of age is present for all modes analyzed (car-driving, car-passenger, and bus) it is considerably more marked for car-driving; 2) There are significant gender effects compounded by the interrelated factors of employment constraints, household dynamics, and greater reliance on travel modes other than car driving; and 3) Neighbourhoods with high commercial and residential mix showed a negative relation with distance traveled only in the case of car-driver.
Since 2006, baby-boomers are beginning to reach the age of 60. This historic milestone forecasts serious challenges for our societies. In particular, the financial security of future pensioners constitutes an important issue.
The present study will attempt to assess the financial preparation for retirement of the Quebec first cohorts of baby boomers born in 1946- 1955, who will retire in the forthcoming years, by comparing their situation with their Ontarian counterparts.
This study is composed of four distinct parts. First, the methodology of the study will be explained. After a literature review, some indicators will be selected to measure the financial preparation to retirement from three points of view. Thus, the objective health of the financial preparation to retirement will be analyzed by comparing Quebec and Ontario. The relative situation of the Quebec first cohorts of baby boomers, illustrated by their revenue, their housing status and their patrimony, will also be explained. The third part of the study tries to compare the first cohorts of baby boomers’ subjective health of the preparation for retirement between the two provinces, for some socioeconomic categories, by using data concerning their satisfaction and their perspectives toward this issue. Finally, this study ends with a comparison of the various strategies used by the Quebec and Ontario first cohorts of baby boomers in order to assure themselves a suitable financial security for retirement, considering the actual trends of the socioeconomic conditions.
The data analyzed come from various Statistics Canada surveys. In particular, demographic census data were used for the period covering 1971-2001, as well as the Survey of Financial Security (SFS) for 1999 and General Social Survey (GSS) for 2002.
Previous research (Gee, Kobayashi, Prus, 2004) indicates that foreign- born older adults (65 years and older) have poorer health than their Canadian-born counterparts. Using data from the 2000/2001 Canadian Community Health Survey, the current study tests two hypotheses to explain the health gap between these two groups. Findings indicate support for the differential vulnerability hypothesis but not for the differential exposure hypothesis in explaining the health gap between Canadian- and foreign-born older adults. What this suggests is that differences in health status between these two groups, rather than being the result of different social locations and/or lifestyle behaviours, can instead be attributed to the different “reactions” of Canadian- and foreign- born older adults to various social and lifestyle determinants of health.
This paper focuses on the transitions that mark middle age (e.g., the ‘empty nest’, caregiving) and are triggered by the occurrence of life events in families (e.g., adult children leaving home, care for aging parents). It is noted that home-leaving by adult children has been taking longer in recent years, and in many instances adult children return to their natal home after having left. Support for older parents is becoming a significant issue in Canada as a result of population aging. Of course, the experience of such life events as taking care of older parents varies according to individuals’ situations, and these can be quite varied. The paper therefore examines some of the diversity of mid-life families by describing patterns of separation and divorce, remarriage, same-sex relationships, and childlessness. It concludes with a discussion of the relationship between mid-life families and social policy.
Many analysts expect the aging population to lead to a reduction in the growth of living standards. Income inequality – a problem that has been accentuated by the payroll tax hikes that were necessary to fund the public pension as the population ages – is becoming an increasing challenge at the same time. As a result, policy-makers need to pursue initiatives that can simultaneously address both our efficiency and our equity objectives. With the challenge of the aging population, it is all the more important that we not rely on fiscal policies that involve a trade-off between growth and equality. This paper identifies a strategy for tax policy that meets these objectives.
The aging population has raised at least two concerns about tax policy. First, taxes will need to be increased to cover higher public-pension and medical-care expenses when baby boomers have retired. Second, taxes can be cut in the meantime, as the government realizes the "fiscal dividend" that accompanies its debt reduction program (that has been motivated by the aging population development). This paper uses a simple endogenous growth analysis to examine these issues. It is assumed that sales tax increases are infeasible on political grounds. Two conclusions emerge: the income tax rate levied on domestic residents should be cut during the debt-reduction period, and the tax rate on foreigners whose capital is operating in Canada should be increased later on when the bulk of the baby boomers have retired.
Health scientists often use observational data to estimate treatment effects when controlled experiments are not feasible. A limitation of observational research is non-random selection of subjects into different treatments, potentially leading to selection bias. The 2 commonly used solutions to this problem – covariate adjustment and fully parametric models – are limited by strong and untestable assumptions. Instrumental variables estimation can be a viable alternative. In this paper, I review examples of the application of IV in the health and social sciences, I show how the IV estimator works, I discuss the factors that affect its performance, I review how the interpretation of the IV estimator changes when treatment effects vary by individual, and consider the application of IV to nonlinear models.
Although immigration has become a major growth factor for Canadian labour force, there is little economic research on the effect of immigration on native-born Canadians' labour market performance. This paper examines the relationship between changes in the share of immigrants by sub-labour markets (categorized by skill types and geographic areas) and changes in native wage growth by a two-stage regression analysis, using 1991, 1996 and 2001 Canadian Census microdata. After accounting for biases due to native mobility, endogenous location of immigrants and labour demand shifts, the estimated effects of immigration are consistently insignificant or significantly positive. The results are robust over various specifications of sub-labour markets at city, provincial and national levels, suggesting no evidence for a negative impact on native wage growth rate from the large immigrant influx during the 1990s.
Background: This study was undertaken to examine the association between caregiver employment status and the time to institutionalization of persons with dementia. No study has previously examined this association.
Methods: The database of the Canadian Study of Health and Aging was used to obtain data on 326 caregiver/care-recipient dyads. Caregivers were primary, informal carers; care-recipients were diagnosed with dementia and living in the community at baseline. Care-recipients were followed from the date of their baseline screening interview until the date of institutionalization, the date of death before institutionalization, or the date of the 5-year follow-up interview. An accelerated failure time model with a Weibull distribution was used to conduct the survival analysis.
Results: During the 5-year follow-up period, 139 care-recipients (45%) were institutionalized; the median time to institutionalization was 1,821 days (95% confidence interval [CI]: 1,539-1,981 days) for the care-recipients of employed caregivers and 1,542 days (95% CI: 1,284-1,653 days) for the care-recipients of unemployed caregivers (p = 0.0634). The adjusted acceleration factor was 1.85 (95% CI: 1.08-3.86), controlling for caregiver thoughts about institutionalizing the care-recipient, caregiver health, and the use of a day center to help provide care.
Conclusions: For the care-recipients of employed caregivers, the adjusted time to institutionalization was longer than for the care- recipients of unemployed caregivers.
The mental and physical health of dementia caregivers has been shown to be worse than that of non-caregivers. The present study was undertaken to investigate whether the caregivers of persons who take medications for behavior and mood problems in dementia are less depressed, and perceive their overall health to be better, than the caregivers of persons who do not take such medications. Behavior and mood medications include anti-psychotics, anti- depressants, and anti-convulsants. The Canadian Study of Health and Aging was used to identify informal, unpaid caregivers of persons with dementia (i.e., Alzheimer's disease, vascular dementia, or other dementia [e.g., Parkinson's disease]). The caregivers of persons diagnosed with cognitive impairment not dementia or no cognitive impairment were also included in the study. Care-recipient use of behavior and mood medications was not found to affect caregiver depression (OR = 1.02; 95% CI = 0.62 to 1.66) or caregiver's perceived overall health (OR = 1.35; 95% CI = 0.80 to 2.27).
The paper investigates whether self-assessed health status (SAH) contains information about future mortality and morbidity, beyond the information that is contained in standard "observable" characteristics of individuals (including pre-existing diagnosed medical conditions). Using a ten-year span of the Canadian National Population Health Survey, we find that SAH does contain private information for future mortality and morbidity. Moreover, we find some evidence that the extra information in SAH is greater at older ages.
Many developed countries are experiencing a major shift from defined benefit (DB) to defined contribution (DC) pension arrangements. One consequence of this shift is an effective delay in the age at which workers commit to an annuity. Our results therefore suggest that adverse selection problems in annuity markets could be more severe at older ages, and therefore, that the DB to DC shift may expose workers to greater longevity risk. This is an aspect of the DB to DC shift that has received little attention.
The federal government has implemented an earned income tax credit what it has called the Working Income Tax Benefit in the 2007 Budget. Edmund Phelps has argued that the earned income tax credit in the United States should be replaced with an employment subsidy. This paper assesses the importance of Phelps' concern, and related issues, for Canada. This debate is important for two reasons: the plight of those blocked by the "welfare wall" is dire, and the entire community has an interest in lower structural unemployment in an environment that involves an aging population and an accompanying labour shortage.
Several studies suggest that, on the basis of life expectancy (LE) regressions, new pharmaceutical drugs are responsible for some of the marked gains in LE observed over the last 50 years. We critically appraise these studies. We point out several modeling issues, including disentangling the contribution of new drugs from advances in disease management, changes in the distribution of health care and other confounding factors. We suggest that the studies estimates of pharmaceutical productivity are implausibly high. Some of the models have very large forecast errors. Finally, the models that we replicated were found to be sensitive to seemingly innocuous changes in specification. We conclude that it is difficult to estimate the bio-medical determinants of LE using aggregate data. Analyses using individual level data or perhaps disease specific data will likely produce more compelling results.
This paper analyses the relationship between cognitive functioning and employment among older men and women using data from the English Longitudinal Study of Ageing. Regression analysis shows that the change in cognitive functioning over time does not have any statistically significant effects on the probability to exit or enter employment, or on working hours. These results are not sensitive to the definition of work. My findings differ from earlier research on younger age groups in Germany and the USA where some effects of cognitive functioning on labour force participation were found.
Drawing on recent historical institutionalist scholarship, this paper explores the debates leading to the enactment of the Canada/Quebec Pension Plans (C/Q.P.P.) in 1965. More specifically, this analysis underlines the respective role of and the interaction between political institutions, business and labor power, and changing ideas about the role of public and private pensions in Canada. As argued, although the ideas that guided the enactment of C/Q.P.P. stressed the key role of private benefits, the enduring weight of Canadian-style federalism mitigated the impact of interest groups, especially business organizations, on the legislative process. Overall, the paper suggests that students of social policy should pay closer attention to the interaction between political institutions, interest group mobilization, and changing ideas about the relationship between public and private benefits.
The cost of the Canadian health care system is approximately 10% of Gross Domestic Product (GDP). Survey-evidence suggests that Canadians do not wish to have additional funds spent on health care but believe that the system should be able to deliver better quality care. Due to low fertility rates and increasing life expectancy, the Canadian population is aging. Over the next 25 years, the dependency ratio will increase, primarily due to the aging of the “baby boom generation” 2. This will place twofold cost pressures on governments responsible for maintaining the health care system:
In Section II, this paper examines a number of different approaches to health care financing including user fees and alternative compensation methods for physicians. The paper highlights documented information from Canada and international experience on the implementation issues involved. The paper evaluates the desirability of implementing these approaches in Canada.
Objectives: This study examined the associations among coping humor, other personal/social factors, and the health status of community-dwelling older adults.
Method: Survey questionnaires were completed with 73 community dwelling older adults. Included were measures of coping humor, spirituality, self-efficacy, social support and physical and mental health status.
Results: Correlations across all variables showed coping humor to be significantly associated with social support, self-efficacy, depression, and anxiety. Forward stepwise regression analyses showed that coping humor and self-efficacy contributed to outcome variance in measures of mental health status. Contrary to expectation, neither social support nor spirituality contributed to the total outcome variance on any of the dependant measures.
Conclusion: The importance of spirituality, self-efficacy and social support in determining the quality of life of older adults is well supported in the literature. Coping humor as a mechanism for managing the inevitable health stresses of aging has received less attention. This study shows that coping humor and self efficacy are important factors for explaining health status in older adults. Correlations among coping humor, self efficacy, and social support suggest that a sense of humor may play an important role in reinforcing self-efficacious approaches to the management of health issues.
Errors introduced by using aggregate data in estimating a consumer demand model have long been a concern. We study the effects of such errors on elasticity estimates derived from AIDS and QUAIDS models. Based on a survey of published articles, a generic parameterization of the income distribution, and the range of Gini coefficients reported for 28 OECD countries, we generate and analyse a large number of “observations” on the differences between elasticities calculated at the aggregate level and those calculated at the micro level. We suggest a procedure for evaluating the likely range of aggregation error when a model is estimated with aggregate data.