Complex population projections usually use microsimulation models; in Canada, Statistics Canada has developed a global dynamic microsimulation model named LifePaths in the Modgen programming language to be used in policy research. LifePaths provides a platform to build on for our research program, conjointly with Dr Janice Keefe from Mount Saint Vincent University, on projections of the Canadian chronic homecare needs for the elderly up to 2031 and of the human resources required. Beside marital status, family networks and living arrangements, future health status of the elderly is a key variable, but an intricate one. Since health status transitions were previously conditioned only on age and sex, we will use here the current disability module of LifePaths with longitudinal data from Canada’s National Population Health Survey (NPHS). These new health status transitions are considering other significant explicative variables like marital status, education etc. We will then present projections of future Canadian elderly by health status and a comparison with nine European countries for the Future Elderly Living Conditions in Europe (FELICIE) Research Program which has used the same approach. Our previous researches have shown the importance of future disability level for the management of an elderly society. The main output of the present paper would first produce, with new health scenarios, new estimates for Canada of elderly in poor health, for those aged 75 and over. Secondly, it would produce an interesting comparative analysis, useful especially for implementing new policies for the well-being of the Canadian elderly.
Price and quantity indexes are applied in the analysis of expenditure on physician services in the province of Ontario, Canada, using newly available data files for 1992 and 2004. Price indexes for such services are found to have increased less rapidly than indexes of general inflation and quantity indexes are found to account for the largest share of physician expenditure increases. The quantity indexes imply substantial gains in services per capita, especially for older adults. They imply also an increase in labour productivity for physicians that is somewhat greater than the corresponding increase for the economy at large.
Objectives: The study has two primary goals. First, to test the hypothesis that higher
levels of income inequality are related to lower levels of population health with updated
data from around year 2000. Second, to examine the inequality-health relationship across
the life course with particular focus on old age when income distributions often shift
Design: Correlation techniques were used to assess the relationship between income inequality (Gini ratio) at ages 0+, 25+, 65+, 75+, and 85+ and life expectancy at corresponding ages (0, 25, 65, 75, 85) by sex, before and after adjusting for average population income. Analyses were conducted on two sets of data: 18 wealthy countries and 28 wealthy and non-wealthy countries.
Data sources: International cross-sectional data on income and life expectancy from about year 2000 were derived from the Luxembourg Income Study and the United Nations Demographic Yearbook respectively.
Results: Among wealthy countries the negative effect of income inequality on life expectancy at birth becomes insignificant after controlling for average absolute income: the correlation coefficient changes from -0.603 to -0.207 for men and -0.605 to 0.024 for women. A similar pattern is observed at age 25. By contrast, the effect becomes increasingly positive and significant across old age, notably for males, regardless of adjustments for average population income or countries of observation.
Conclusions: These updated results do not support the inequality-health hypothesis. The relationship between income inequality and life expectancy at earlier ages in wealthy countries can be explained by the confounding effect of average absolute income. In old age the data are entirely contrary to the hypothesis. More research is needed to understand the mechanisms that facilitate the increasing positive effect of income inequality on life expectancy in late life.
This study examines health differences between first-generation immigrant and Canadian-born persons who share the same the ethnocultural origin, and the extent to which such differences reflect social structural and health-related behavioural contexts. Data from the 2000/2001 Canadian Community Health Survey show that first generation immigrants of Black and French race/ethnicity tend to have better health than their Canadian-born counterparts, while the opposite is true for those of South Asian, Chinese, and south and east European and Jewish origins. West Asians and Arabs and other Asian groups are advantaged in health regardless of country of birth. Health differences between ethnic foreign- and Canadian-born persons generally converge after adjusting for socio-demographic, SES, and lifestyle factors. Implications for health care policy and program development are discussed.
Since the concept of retirement is prominent in both popular thinking and academic studies it would be helpful if the notion were analytically sound, could be measured with precision, and would make possible comparisons of patterns of retirement over time and among different populations. This paper reviews and assesses the many concepts and measures that have been proposed, summarizing them in groupings that reflect non-participation or reduced participation in the labour force, receipt of pension income, end-of-career employment, selfassessed retirement, or combinations of those characteristics. It concludes that there is no agreed measure and that no one measure dominates. Instead, new measures continue to be proposed to take account of additional refinements as new data sets become available, thereby further restricting possible comparisons. The confusing array of definitions reflects the practical problem that underlies the concept of retirement: it is an essentially negative notion, a notion of what people are not doing – namely, that they are not working. A more positive approach would be to focus instead on what people are doing, including especially their involvement in non-market activities that are socially productive, even if those activities do not contribute to national income as conventionally measured.
The purpose of this paper is to examine what key reform attempts during the Bill Clinton and George W. Bush presidencies reveal about the wider possibilities for social policy change in the United States. Most particularly, why were Presidents Clinton and Bush able to achieve their goals in some policy realms but so badly defeated in others? As argued, institutional variation from one policy area to another helps answer this question. On the one hand, strong institutional obstacles in the fields of Social Security and health insurance largely explain the defeat of the most ambitious social policy proposal put forward by each president. On the other hand, successful reforms occurred in a comparatively favourable institutional context. Yet, the analysis also suggests that paying close attention to the strategic ideas of political actors as they interact with existing institutions and policy legacies is necessary to fully understand the politics of social policy reform.
This article argues that an increase of the retirement age from 65 years to 67 or higher, which is the most unpopular pension reform measure, is politically feasible if the major parties build either a formal or an informal grand coalition. It argues further that institutional rules and agreed standards, especially the goals expressed in relation to pension policy, facilitate the formation of a grand coalition and increase the autonomy of governments vis-à-vis trade unions. Specifically, by restricting key policy instruments for responding to fiscal pressures, they lead political parties to consider the controversial option of raising the retirement age and to engage in a coordinative discourse about the necessity of this change and the limits of other reform options. This argument implies that the success of a retirement age reform does not depend on a negotiated agreement between a government and trade unions. By examining the agenda-setting and decisionmaking processes in Germany from the mid-1990s to 2007, this article shows that governments raise the retirement age only if they face constraints that rule out tax increases and benefit cuts and that they are able to enact even comprehensive retirement age reforms that increase not only the normal age but also the earliest eligibility age for both public and private pensions.
The home health care sector in Canada experienced major restructuring in the mid-1990s creating a variety of flexibilities for organizations and insecurities for workers. This paper examines the emotional and physical health consequences of employer flexibilities and worker insecurities on home health care workers. For emotional health the focus is on stress and for physical health the focus is on selfreported musculoskeletal disorders. Data come from our survey of home health care workers in a mid-sized city in Ontario, Canada. Data are analyzed separately for 990 visiting and 300 office workers.
For visiting workers, results showed that none of the ‘objective’ flexibility/insecurity measures are associated with stress or musculoskeletal disorders controlling for other factors. However, ‘subjective’ flexibility/insecurity factors, i.e. feelings of job insecurity and labour market insecurity, are significantly and positively associated with stress. When stress is included in the analysis, for visiting workers stress mediates the effects of ‘subjective’ flexibility/insecurity with musculoskeletal disorders. For office workers, none of the objective flexibility/insecurity factors are associated with stress but subjective flexibility/insecurity factor of feelings of job insecurity is positively and significantly associated with stress. For office home care workers, work on call is negatively and significantly associated with musculoskeletal disorders. Feeling job insecurity is mediated through stress in affecting musculoskeletal disorders. Feeling labour market insecurity is significantly and positively associated with musculoskeletal disorders for office home care workers. Decision-makers in home care field are recommended to pay attention to insecurities felt by workers to reduce occupational health problems of stress and musculoskeletal disorders.
Focusing on Canada, this paper explores the politics of social policy retrenchment and restructuring in two policy areas: old-age pensions, especially the Canada Pension Plan (CPP), and Employment Insurance (EI) [formerly Unemployment Insurance (UI)]. Drawing on historical institutionalism and the literature on ideas and policy change, the paper explains key differences between these two policy areas. The analysis shows that institutional factors like federalism explain some of the differences between the policy areas and programs at stake. Yet, to complement this analysis, the paper also highlights the political consequences of changing ideas and assumptions among policy-makers, which vary strongly from one program to another. In other words, ideational and institutional factors combined to produce distinct patterns of policy change. Overall, the paper suggests that scholars can draw a clear analytical line between ideational and institutional factors before combining them to explain specific episodes of policy change. From a methodological standpoint, the paper also demonstrates the added value of systematic comparisons between distinct policy areas located within the same country.
Post-war policies and subsequent debates had two policy targets: reducing old-age poverty and enhancing income security for the “average worker” after retirement. While we know a lot about the first issue, the second has received less attention as a result of data limitations. We take advantage of unique longitudinal data based on Canadian tax files (the LAD) to examine income replacement rates of older Canadians relative to their economic status when they were in their mid-fifties. In 2005, the replacement income of retired individuals in their mid-seventies who were in the middle of the income distribution at age 55 (in the early 1980s) was between 70 and 80 percent of their previous incomes some 20 years earlier This figure is at the high end of the range (65 to 75 percent) that experts generally consider “adequate” for middle-income retirees to maintain their pre-retirement living standards. However, we also show that there is considerable variation in replacement rates. By age 75, about a quarter of middle-income persons had retirement incomes of less than 60 percent of the income they were receiving in their mid-fifties, a result of differential access to private pension income. We also ask whether income replacement rates have been rising or falling among more recent cohorts of retirees but find little change. Finally, we report results about the stability of incomes in the retirement years. We conclude that year to year instability in family income declines for both high and low income earners as they age, largely because of the stabilizing effect of public pension income sources.
Pension benefit guarantee policies have been introduced in several countries to pro- tect private pension plan members from the loss of income that would occur if a plan was underfunded when the sponsoring firm terminates a plan. Most of these public insurance schemes face financial dificulty and consequently policy reforms are being discussed or implemented. Economic theory suggests that such schemes will face moral hazard and adverse selection problems. In this note we test a specific theoretical predic- tion: insured plans will invest more heavily in risky assets. Our test exploits differences in insurance arrangements across Canadian jurisdictions. We find that insured plans invest about 5 percent more in equities than do similar plans without benefit guarantees.
Breast cancer is a leading source of mortality among Canadian women; however early detection via mammography considerably improves survival rates. Accordingly, national guidelines advocate biennial screening for asymptomatic women aged 50 to 69 years. Unfortunately many women do not abide by such recommendations, and there is some evidence that compliance rates are lower in rural areas. This report explores the extent of regional variation within and between Canadian provinces using a new and more detailed set of rural indicators based on economic zones of influence. We find the incidence of ever having a mammogram and screening within the last two years are significantly lower for women most removed from large urban centers. This result is obtained after controlling for demographic and socio-economic characteristics, concentration of physicians and specialists in the local area and whether the woman has a regular family doctor. An important reason for the observed differences across rural and urban areas is found to be awareness of the need for regular screening. We also observe that differences in mammography usage between rural and urban areas vary significantly across Canadian provinces.