Rose Anne Devlin

The Payoff to Work without Pay: Volunteer Work as an Investment in Human Capital

Despite the widespread belief that volunteer work enhances an individuals employment prospects, the hypothesis that volunteer work increases ones earnings has never been empirically verified. Using a recent Canadian data set, the authors test this hypothesis by estimating human capital earnings equations that include dummy variables representing to distinguish volunteers from nonvolunteers. The results suggest that the return to volunteering amounts to 6-7 percent of annual earnings.

Do physician remuneration schemes matter? The case of Canadian family physicians.

Although it is well known theoretically that physicians respond to financial incentives, the empirical evidence is quite mixed. Using the 2004 Canadian National Physician Survey, we analyze the number of patient visits per week provided by family physicians in alternative forms of remuneration schemes. Overwhelmingly, fee-for-service (FFS) physicians conduct more patient visits relative to four other types of remuneration schemes examined in this paper. We find that family physicians self-select into different remuneration regimes based on their personal preferences and unobserved characteristics; OLS estimates plus the estimates from an IV GMM procedure are used to tease out the magnitude of the selection and incentive effects. We find a positive selection effect and a large negative incentive effect; the magnitude of the incentive effect increases with the degree of deviation from a FFS scheme. Knowledge of the extent to which remuneration schemes affect physician output is an important consideration for health policy.

Volunteerism and Crowding Out: Canadian Econometric Evidence

Volunteers make an important contribution to Canadian society. The authors address what motivates people to volunteer and whether they respond to government expenditure decisions using a 1987 microdata set and find that, while the level of government spending influences the decision to volunteer, it has no effect on the number of hours donated. Furthermore, the nature of this relationship depends upon the particular type of government expenditures. For instance, the number of volunteers contracts when expenditures on certain economy-related activities fall, while reductions in health-care spending bring about an increased number of volunteers.

Liability Versus No-Fault Automobile Insurance Regimes: An Analysis of the Experience in Quebec

This paper examines the debate regarding the incentive effects of legal liability in the presence of liability insurance. Specifically, it examines the impact on road accidents of moving from a liability to a no-fault automobile insurance regime. A model is developed in which individuals choose driving care and kilometers driven within each type of insurance system. The theoretical results from the choice of care and kilometers suggest that the overall direction of change in each of these variables is an empirical matter. An investigation is conducted of the province of Quebec which switched to a pure no-fault system for all bodily-injury accidents in 1978. The empirical results indicate that there was an increase in total kilometers driven, and that driving care fell in the new insurance regime. These results suggest that there may indeed be a deterrence effect stemming from legal liability in the presence of liability insurance.

Can volunteer work help explain the male-female earnings gap?

Using the 1987 Survey of Volunteer Activity in Canada, we examine whether differential returns to volunteer work in the paid labour market can explain part of the male-female earnings gap. Male volunteers earn, on average, about 11% higher incomes than their non-volunteering counterparts as a result of their volunteer experience, whereas comparable female volunteers and non-volunteers earn similar incomes. This differential return across the sexes may be partially explained by the type of volunteer activity undertaken. Our results indicate that as much as one third of the male-female earnings gap may be attributable to the fact that the labour market rewards male and female volunteers differently.

Charitable Giving, Volunteering, and the Paid Labor Market

Among the few articles that jointly determine an individuals gifts of time and money, there exists disagreement as to whether these gifts are complements or substitutes. The authors try to shed some light on this debate by expanding the analysis of private contributions to take account of whether or not the individual is working in the paid labor market. The analysis indicates that gifts of time and money are largely complementary to each other, especially for employed individuals. The donations of employed males also appear to be crowded out by government expenditures. The fact that employment status as well as gender affect how individuals respond to fiscal stimulus may have important policy implications.

The Nonprofit Sector in Canada: Roles and Relationships

The size and complexity of the not-for-profit sector, the role of religious organizations in the delivery of social services, the distinctive roles of not-for-profits in caring for the elderly in Ontario and Quebec, the advocacy role of ethno-cultural organizations at the national level, and accountability dilemmas facing not-for-profit organizations are just some of the topics tackled in this book, illustrating the rich diversity of the not-for-profit sector.

Physician's Production of Primary Care in Ontario, Canada

This paper examines the factors affecting the number of patient visits per week reported by family physicians in Ontario. The way that a physician is paid is potentially endogenous to the number of patients seen per week, thus an instrumental variable method of estimation is employed to account for the endogeneity bias. Once account is taken of the endogeneity of remuneration as well as relevant physician and practice characteristics, the estimated elasticity of output with respect to hours worked is 0.74; 0.68 in group practices and 0.82 in solo practices. Physicians paid on a non-fee-for-service (NFFS) conduct 15-31% fewer patient visits per week in comparison to those paid under an FFS scheme. Certain patient populations in practices affect patient visits in important ways, as do a number of physician and practice characteristics.

Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity

OBJECTIVES To investigate the impact of the mode of remuneration on the work activities of Canadian family physicians on: (a) direct patient care in office/clinic, (b) direct patient care in other settings and (c) indirect patient care. METHODS Because the mode of remuneration is potentially endogenous to the work activities undertaken by family physicians, an instrumental variable estimation procedure is considered. We also account for the fact that the determination of the allocation of time to different activities by physicians may be undertaken simultaneously. To this end, we estimate a system of work activity equations and allow for correlated errors. RESULTS Our results show that the mode of remuneration has little effect on the total hours worked after accounting for the endogeneity of remuneration schemes; however it does affect the allocation of time to different activities. We find that physicians working in non-fee-for-service remuneration schemes spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings, and more hours on indirect patient care. CONCLUSIONS Canadian family physicians working in non-fee-for-service settings spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings and devote more hours to indirect patient care. The allocation of time in non-fee-for-service practices may have some implications for quality improvement.

An evaluation of gender equity in different models of primary care practices in Ontario

BackgroundThe World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist.MethodsThis cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108).ResultsHealth service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC).ConclusionsThe observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued.