Byron G. Spencer

Demographic change and the cost of publicly funded health care.

This paper is concerned with questions relating to demographic change (population growth and aging) and its implications for operating a publicly funded health care system in a Canadian setting. It provides an assessment of how prospective population changes alone would affect the share of health care costs in total national income in Canada over the next several decades; it provides also an analysis of how actual patterns of hospital service provision change in Ontario over the last decade in response to budgetary restrictions in a period of rising demand for services. Finally a case is made for viewing health care as an integrated system; a description is provided of a set of computer-based models that have been developed to facilitate analysis of the health care system and illustrative projections are discussed. (EXCERPT)

Health-care costs when the population changes

Health-care costs when the population changes. This paper uses a theoretical model of the complete economic-demographic system to investigate the impact of population change on the relative burden of health-care costs. The model is used in a number of computer simulation experiments under a variety of as- sumptions about the course of fertility and migration. Our analysis suggests that population changes can be expected to have a sub- stantial impact on the costs of health care in the longer term. However, it seems clear that large cost increases which occur within a decade or so must primarily reflect changes in the quality of services provided. Our analysis suggests also that changes in fertility rates are likely to be of much greater quantitative im- portance than are changes in migration rates.

The Future Population of Canada, Its Age Distribution and Dependency Relations

This paper makes available a number of projections of the age-sex distribution of the Canadian population for the 45-year period 1996 to 2041 and comparisons with the previous 45-year period. The projections combine assumptions relating to fertility mortality and migration.... It is concluded that substantial aging of the Canadian population appears virtually certain but based on the demographic evidence the `dependency burden is likely to remain below the peak levels attained during the baby boom. (EXCERPT) (SUMMARY IN FRE)

Age, Trend, and Cohort Effects in a Macro Model of Canadian Expenditure Patterns

A quadratic almost ideal demand system allowing for age, cohort, and trend effects is developed at the macro level. The model is estimated by maximum likelihood, using a three-tier iterative/search method applied to pooled 1961–1992 time series for five regions of Canada and six categories of expenditure. Hypothesis tests indicate support for the model specification. Elasticities are compared with those reported in other studies, with special attention to food. Effects of demographic and trend variables on elasticities and expenditure shares are investigated. An overall conclusion is that such effects can be very important in a macro demand system.

The small sample bias of Durbin's tests for serial correlation: When one of the regressors is the lagged dependent variable and the null hypothesis is true

Abstract Durbin (1970) has recently proposed two asymptotically equivalent statistics which can be used to test for the presence of serial correlation when some of the regressors are lagged dependent variables. This study reports on simulation experiments designed to compare the two statistics, in use with small samples, in terms of their tendencies to detect serial correlation when none exists. Of the two test statistics, it is found that the one based on estimated residuals detects the absence of serial correlation in the expected proportion of trials; the other statistic (Durbins h), which involves the application of a correction factor to the Durbin-Watson statistic, gives evidence of serious small sample bias which varies with both the sample size and the assumed size of the coefficient attaching to the lagged dependent variable.

A Simulation Analysis of the Effects of Population Change on a Neoclassical Economy

This paper is concerned with the effects of variations in demographic factors on the time paths of major economic variables. A theoretical macromodel of an economic-demographic system is specified, with numerical parameters. This model is used in computer simulations to study the economic effects of exogenous changes in fertility and immigration rates. A cohort approach is emphasized in the specification of both demographic and economic relationships. Simulation results are reported for a variety of real and artificial time patterns of fertility and immigration under different assumptions about the values of the principal parameters of the economic relationships.

Prospective Aging of the Population and its Implications for the Labour Force and Government Expenditures.

The impact on the labor force of prospective changes in the age distribution of the population of Canada is explored. The history of population and labor force change in Canada and the province of Ontario is first reviewed. Projections to the year 2030 are then presented. The authors conclude by considering the implications of these demographic changes for government expenditure patterns. (ANNOTATION)

The SHARP way to plan health care services: A description of the system and some illustrative applications in nursing human resource planning

Abstract SHARP provides an analytical framework that for the first time brings together all major elements of the health care system and helps to organize our thoughts about the system as a system . (The acronym stands for System for Health Area Resource Planning; SHARP has been developed for Ontario, the largest of the Canadian provinces.) A framework for discussion is especially important during the current period of “health reform”, spurred largely by concerns to bring cost increases under control. The central message of this paper is that the planning process should be well informed and should take an integrated view of the health care system so that major future repercussions of actions taken today can be foreseen (albeit imperfectly). In reforming the system, it is important to anticipate both the requirements for health care services and the resources that are likely to be available to satisfy those requirements. That is where SHARP can be helpful. With its comprehensive and forward-looking view of the health care system, SHARP can usefully inform the current debate about the future of the health care sector. The main features of SHARP are described and the system is illustrated with special reference to nurses and the services that they provide.

Potential savings from the adoption of nurse practitioner technology in the Canadian health care system

An investigation is reported of the potential for reducing aggregate medical costs by the introduction of nurse practitioners into the Canadian health care system to an extent consistent with demonstrated safety and effectiveness. A cost model is developed for this purpose and estimates of its parameters are provided. The cost model is coupled with a demographic projection model and potential cost reductions are simulated over the period 1980-2050, under alternative assumptions. Results suggest that savings could have been in the range 10-15% in 1980 for medical services as a whole, and 16-24% for ambulatory services. The estimated savings percentages are quite insensitive to projected changes in the age structure of the Canadian population.

Who Signs China's One-Child Certificate, and Why?

Chinas policy of one child per family was put in place in 1979 to control population growth in the worlds most populous nation. Who complies with the policy, and why? What guidance does economic theory provide? Using microdata available from the 1985 Chinese In-Depth Fertility Survey, a multinomial logit model of family choice with respect to policy compliance is estimated. The results indicate that even after area of residence is taken into account, womans education, husbands occupation, marriage duration, presence of a son, family structure, and house size significantly influence compliance, while age, child mortality experience, husbands education and womans occupation apparently do not. The effects of income and wealth remain open questions. Possible explanations are provided.