Logan McLeod

PHYSICAL ACTIVITY AND HEALTH OUTCOMES: EVIDENCE FROM CANADA

Health production models include participation in physical activity as an input. We investigate the relationship between participation in physical activity and health using a bivariate probit model. Participation is identified with an exclusion restriction on a variable reflecting sense of belonging to the community. Estimates based on data from Cycle 3.1 of the Canadian Community Health Survey indicate that participation in physical activity reduces the reported incidence of diabetes, high blood pressure, heart disease, asthma, and arthritis as well as being in fair or poor health. Increasing the intensity above the moderate level and frequency of participation in physical activity appears to have a diminishing marginal impact on adverse health outcomes. Our results provide support for guidelines about engaging in exercise regularly to achieve health benefits.

Cigarette Taxes and Older Adult Smoking: Evidence from Recent Large Tax Increases

While recent evidence casts some doubt, it is generally accepted that the price sensitivity of smoking varies inversely with age. We investigate the responsiveness of older adult smoking using variation from recent historically large cigarette tax increases in the United States. Using data from the Behavioral Risk Factor Surveillance System from 2000 to 2005, we find consistent evidence that higher taxes reduced smoking participation by older adults, especially those who are less educated and live in low-income households. Our findings run contrary to existing evidence which suggests that cessation behavior by older adults is not sensitive to price. Since a large literature suggests smoking cessation even later in life reduces morbidity and increases longevity, our findings may represent substantial gains in health among tax-induced quitters.

Willingness-to-Pay for Parallel Private Health Insurance: Evidence from a Laboratory Experiment

Debate over the effects of public versus private health care finance persists in both academic and policy circles. This paper presents the results of a revealed preference laboratory experiment that tests how characteristics of the public health system affect a subjects willingness-to-pay (WTP) for parallel private health insurance. Consistent with the theoretical predictions of Cuff et al. (2010), subjects’ average WTP is lower and the size of the private insurance sector smaller when the public system allocates health care based on need rather than randomly and when the probability of receiving health care from the public system is high. (Les debats continuent quant aux effets compares du financement prive et public des soins de santea la fois dans le monde academique et le monde des definisseurs de politiques. Ce memoire presente les resultats d’une experience de laboratoire destinee a reveler les preferences et a montrer comment des caracteristiques du systeme public de soins de sante affectent la volonte de payer pour des services paralleles d’assurance sante privee. En ligne avec les predictions theoriques de Cuff et al. (2010), la volonte moyenne de payer est plus faible et la taille du secteur de l’assurance privee plus petite quand le regime public est fonde sur les besoins plutot qu’aleatoire, et quand la probabilite de recevoir les soins du regime public est elevee.)

A nonparametric vs. latent class model of general practitioner utilization: Evidence from Canada

Predicting health care utilization is the foundation of many health economics analyses, such as calculating risk-adjustment capitation payments or measuring equity in health care utilization. The most common econometric models of physician utilization are parametric count data models, since the most common metric of physician utilization is the number of physician visits. This paper makes two distinct contributions to the literature analyzing GP utilization: (i) it is the first to use a nonparametric kernel conditional density estimator to model GP utilization and compare the predicted utilization with that from a latent class negative binomial model; and (ii) it uses panel data to control for the potential endogeneity between self-reported health status and the number of GP visits. The goodness-of-fit results show the kernel conditional density estimator provides a better fit to the observed distribution of GP visits than the latent class negative binomial model. There are some meaningful differences in how the predicted conditional mean number of GP visits changes with a change in an individuals characteristics, called the incremental effect (IE), between the kernel conditional density estimator and the latent class negative binomial model. The most notable differences are observed in the right tail of the distribution where the IEs from the latent class negative binomial model are up to 190 times the magnitude of the IEs from the kernel conditional density estimator.

Willingness-To-Pay for Parallel Private Health Insurance: Evidence from a Laboratory Experiment (Volonté De Payer Pour Des Services Parallèles D’Assurance Santé: Résultats D’Une Expérience De Laboratoire)

Debate over the effects of public versus private health care finance persists in both academic and policy circles. This paper presents the results of a revealed preference laboratory experiment that tests how characteristics of the public health system affect a subjects willingness-to-pay (WTP) for parallel private health insurance. Consistent with the theoretical predictions of Cuff et al. (2010), subjects’ average WTP is lower and the size of the private insurance sector smaller when the public system allocates health care based on need rather than randomly and when the probability of receiving health care from the public system is high. (Les debats continuent quant aux effets compares du financement prive et public des soins de santea la fois dans le monde academique et le monde des definisseurs de politiques. Ce memoire presente les resultats d’une experience de laboratoire destinee a reveler les preferences et a montrer comment des caracteristiques du systeme public de soins de sante affectent la volonte de payer pour des services paralleles d’assurance sante privee. En ligne avec les predictions theoriques de Cuff et al. (2010), la volonte moyenne de payer est plus faible et la taille du secteur de l’assurance privee plus petite quand le regime public est fonde sur les besoins plutot qu’aleatoire, et quand la probabilite de recevoir les soins du regime public est elevee.)

Towards an understanding of the structural determinants of oral health inequalities: A comparative analysis between Canada and the United States

Objective To compare the magnitude of, and contributors to, income-related inequalities in oral health outcomes within and between Canada and the United States over time. Methods The concentration index was used to estimate income-related inequalities in three oral health outcomes from the Nutrition Canada National Survey 1970–1972, Canadian Health Measures Survey 2007–2009, Health and Nutrition Examination Survey I 1971–1974, and National Health and Nutrition Examination Survey 2007–2008. Concentration indices were decomposed to determine the contribution of demographic and socioeconomic factors to oral health inequalities. Results Our estimates show that over time in both countries, inequalities in decayed teeth and edentulism were concentrated among the poor and inequalities in filled teeth were concentrated among the rich. Over time, inequalities in decayed teeth increased and decreased for measures of filled teeth and edentulism in both countries. Inequalities were higher in the United States compared to Canada for filled and decayed teeth outcomes. Socioeconomic characteristics (education, income) contributed greater to inequalities than demographic characteristics (age, sex). As well, income contributed more to inequalities in recent surveys in both Canada and the United States. Conclusions Inequalities in oral health have persisted over the past 35 years in Canada and the United States, and are associated with age, sex, education, and income and have varied over time.

A conceptual framework identifying sources of risk to patient safety in primary care

The potential risks to patient safety in a primary care setting are different than the risks to patient safety in an acute care setting. The main differences arise from the organisational structures of primary care delivery and the greater involvement of patients in their care. To account for these differences, we present the Patient Safety in Primary Care Framework to conceptualise the sources of risk to patient safety.