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Income inequality and mortality: time series evidence from Canada.

https://arctichealth.org/en/permalink/ahliterature183617
Source
Health Policy. 2003 Oct;66(1):107-17
Publication Type
Article
Date
Oct-2003
Author
Audrey Laporte
Brian S Ferguson
Author Affiliation
Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 2nd Floor McMurrich Building, 12 Queen's Park Crescent West, Toronto, Ont., Canada M5S 1A8. audrey.laporte@utoronto.ca
Source
Health Policy. 2003 Oct;66(1):107-17
Date
Oct-2003
Language
English
Publication Type
Article
Keywords
Age Factors
Canada - epidemiology
Cross-Sectional Studies
Health Services Accessibility
Humans
Income - classification - statistics & numerical data
Longitudinal Studies
Models, Statistical
Mortality - trends
National Health Programs - standards
Social Class
Socioeconomic Factors
Abstract
In this paper, we apply the standard model used in the income strand of the socio-economic status (SES)-population health literature to explain the relationship between mortality and income to pooled cross-section time-series data for Canada. The use of time-series data increases the available degrees of freedom and allows for the possibility that the effects of inequality take time to translate into poorer health outcomes. In light of recent criticisms of aggregate level studies, we do not attempt to differentiate between the absolute and relative inequality hypotheses, but test for the existence of a relationship between mortality and a measure of income inequality. We find that whether an exogenous trend is incorporated or an auto-regressive distributed lag form is used, the coefficients on mean income and the Gini are not significantly different from zero, which contradicts the findings in other parts of the literature, but which is consistent with earlier cross-section evidence for Canada. The results suggest that models that focus exclusively on income as a measure of the impact of SES on mortality are not complete and that health spending and unemployment may be even more important than income growth and dispersion.
PubMed ID
14499169 View in PubMed
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Economic and resource status of the chiropractic profession in Ontario, Canada: a challenge or an opportunity.

https://arctichealth.org/en/permalink/ahliterature158354
Source
J Manipulative Physiol Ther. 2008 Feb;31(2):104-14
Publication Type
Article
Date
Feb-2008
Author
Silvano A Mior
Audrey Laporte
Author Affiliation
Division of Research, Canadian Memorial Chiropractic College, Toronto, Canada. smior@cmcc.ca
Source
J Manipulative Physiol Ther. 2008 Feb;31(2):104-14
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Chiropractic - economics - manpower - statistics & numerical data
Databases, Factual
Health Surveys
Humans
Ontario
Patient Acceptance of Health Care - statistics & numerical data
Professional Practice - statistics & numerical data
Abstract
Chiropractic is one of the most frequently sought nonphysician provider groups. Despite its apparent recognition, the profession faces numerous challenges, including the economic reality of an increasing supply within a market of questionable demand. This paper evaluates the chiropractic manpower status in Ontario, Canada.
Data collected from administrative and education databases, insurance billing data, and population health survey data between 1990 and 2004 were analyzed.
Between 1990 and 2004, the total number of chiropractic registrants in Ontario doubled, with an average annual rate of growth of about 5.4%; however, recent data suggest that the number of nonpracticing chiropractors is increasing, whereas the number of new registrants is decreasing. The rate of applications to a chiropractic institution rose sharply and peaked in 1996-1997, thereafter declining but leveling off in 2002-2003. Despite the continued growth in the number of practicing chiropractors, the utilization of chiropractic services among the Ontario population has remained relatively stable, resulting in a decline in the average net annual incomes adjusted for inflation to 2002 dollars.
Our results support previous reports projecting an oversupply of chiropractors and suggest that the chiropractic profession in Ontario is in long-run oversupply. Competition from other providers, changing population demographics, and the recent loss of public funding for services may present significant future challenges to current practitioners. Opportunities related to participation in multidisciplinary environments and accessing unmet population health needs may contribute to influencing the demand for chiropractic services. A concerted effort by professional and educational institutions is required.
PubMed ID
18328936 View in PubMed
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Social capital, community size and utilization of health services: a lagged analysis.

https://arctichealth.org/en/permalink/ahliterature137567
Source
Health Policy. 2011 Nov;103(1):38-46
Publication Type
Article
Date
Nov-2011
Author
Eric Nauenberg
Audrey Laporte
Leilei Shen
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. eric.nauenberg@utoronto.ca
Source
Health Policy. 2011 Nov;103(1):38-46
Date
Nov-2011
Language
English
Publication Type
Article
Keywords
Cross-Sectional Studies
Female
Health Care Surveys
Health Services - utilization
Humans
Male
Middle Aged
Ontario
Patient Acceptance of Health Care - statistics & numerical data
Population Density
Residence Characteristics - statistics & numerical data
Social Support
Abstract
We examine the relationship between social capital, community size and GP visits, and conceptualize social capital as a stock variable measured at a prior point in time.
Data from the 2002 Canadian Community Health Survey and the 2001 Canadian Census are merged with GP visit data from the Ontario Health Ministry. Negative binomial regression is used to measure the impact of community-level (CSC) and individual-level social capital (ISC) on GP visits. CSC is measured with the Petris Index using employment levels in religious and community-based organizations, and ISC is measured along multiple dimensions.
The effect of social capital varies by community size. A one standard deviation increase in the Petris Index in larger communities (population>100,000) leads to a 2.6% decrease in GP visits with an annual offset in public spending of $66.4M. Tangible social support-a measure of ISC-also exhibited large effects on GP visits. In smaller communities (population 10,000-100,000), only increased ISC exhibited an impact on GP visits. Age had no effect on the association between social capital and GP visits.
Each form of social capital likely operates through different mechanisms and impact differs by community size. Stronger CSC likely obviates some physician visits in larger communities that involve counseling/caring services while some forms of ISC may act similarly in smaller communities.
PubMed ID
21269724 View in PubMed
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Quantile regression analysis of the rational addiction model: investigating heterogeneity in forward-looking behavior.

https://arctichealth.org/en/permalink/ahliterature141381
Source
Health Econ. 2010 Sep;19(9):1063-74
Publication Type
Article
Date
Sep-2010
Author
Audrey Laporte
Alfia Karimova
Brian Ferguson
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada. audrey.laporte@utoronto.ca
Source
Health Econ. 2010 Sep;19(9):1063-74
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Behavior, Addictive
Canada
Female
Health Knowledge, Attitudes, Practice
Health Surveys
Humans
Male
Models, Psychological
Models, Statistical
Regression Analysis
Smoking - psychology
Abstract
The time path of consumption from a rational addiction (RA) model contains information about an individual's tendency to be forward looking. In this paper, we use quantile regression (QR) techniques to investigate whether the tendency to be forward looking varies systematically with the level of consumption of cigarettes. Using panel data, we find that the forward-looking effect is strongest relative to the addiction effect in the lower quantiles of cigarette consumption, and that the forward-looking effect declines and the addiction effect increases as we move toward the upper quantiles. The results indicate that QR can be used to illuminate the heterogeneity in individuals' tendency to be forward looking even after controlling for factors such as education. QR also gives useful information about the differential impact of policy variables, most notably workplace smoking restrictions, on light and heavy smokers.
PubMed ID
20730997 View in PubMed
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Observations on institutional long-term care in Ontario: 1996-2002.

https://arctichealth.org/en/permalink/ahliterature175200
Source
Can J Aging. 2005;24(1):70-84
Publication Type
Article
Date
2005
Author
Whitney Berta
Audrey Laporte
Vivian Valdmanis
Author Affiliation
Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto McMurrich Building, 2nd Floor, 12 Queen's Park Crescent, Toronto, ON, M5S 1A8, Canada. whit.berta@utoronto.ca
Source
Can J Aging. 2005;24(1):70-84
Date
2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Homes for the Aged - statistics & numerical data
Humans
Long-Term Care - statistics & numerical data
Nursing Homes - statistics & numerical data
Ontario
Abstract
We provide descriptive statistics for data collected via the Residential Care Facilities Survey (RCFS), from long-term care (LTC) facilities operating in Ontario between 1996 and 2002. The LTC sector in Ontario is dominated by large, proprietary for-profit facilities. The proportion of residents receiving extended care has increased from 53 per cent in 1996 to over 61 per cent in 2002. Government-owned facilities are significantly larger than both for-profit proprietary facilities and lay non-profit facilities. Religious and lay non-profit facilities provide care to more residents 85 years of age and older than do for-profit and government-owned facilities, while government-owned facilities provide care to a greater proportion of higher needs residents. Government-owned facilities have higher nursing intensity levels and higher direct care staffing levels than other ownership types, while for-profit facilities have significantly lower levels than other facility types. Non-profit operators have higher ratios of administrative to care staff than proprietary and government-owned facilities.
PubMed ID
15838827 View in PubMed
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Estimating the economic costs of antidepressant discontinuation during pregnancy.

https://arctichealth.org/en/permalink/ahliterature150292
Source
Can J Psychiatry. 2009 Jun;54(6):399-408
Publication Type
Article
Date
Jun-2009
Author
Lisa O'Brien
Audrey Laporte
Gideon Koren
Author Affiliation
Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario. lobrien14@gmail.com
Source
Can J Psychiatry. 2009 Jun;54(6):399-408
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Antidepressive Agents - contraindications - economics - therapeutic use
Community Health Services - economics - utilization
Cross-Sectional Studies
Depression, Postpartum - economics - epidemiology
Depressive Disorder, Major - drug therapy - economics - epidemiology
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Obstetric Labor, Premature - economics
Ontario
Pregnancy
Pregnancy Complications - drug therapy - economics - epidemiology
Recurrence - prevention & control
Risk assessment
Abstract
Depression is a major public health concern that results in a wide range of economic costs to people, their families, and the health care system. Our study sought to determine the direct medical costs incurred by the Ontario government owing to cessation of antidepressant therapy during pregnancy.
We conducted an economic evaluation by making assumptions based on data obtained from Statistics Canada, federal and provincial government reports, and relevant depression literature. The analysis included the number of pregnant women with depression residing in Ontario and, subsequently, the number of those women who experienced depressive relapse during pregnancy owing to discontinuation of antidepressant medication. The cost of physician services, hospitalizations, and the birth of preterm and low birth weight infants (2 adverse outcomes associated with untreated depression during pregnancy) were also taken into consideration.
An estimated 2953 pregnant women with depression in Ontario annually discontinue antidepressant therapy and subsequently have a depressive relapse. An estimated $20 546 982 is spent annually in Ontario on untreated maternal depression in pregnancy; this is the total after subtracting the cost of risks associated with treated depression during pregnancy ($3 144 053).
Safe treatment options for the management of depression during pregnancy should be actively explored as treated depression translates into cost savings for the Ontario government and society as a whole. Beyond this cost, depression interferes with the quality of childrearing, maternal responsiveness to infants, and other determinants essential for optimal child development.
PubMed ID
19527560 View in PubMed
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Aging, social capital, and health care utilization in Canada.

https://arctichealth.org/en/permalink/ahliterature155173
Source
Health Econ Policy Law. 2008 Oct;3(Pt 4):393-411
Publication Type
Article
Date
Oct-2008
Author
Audrey Laporte
Eric Nauenberg
Leilei Shen
Author Affiliation
Department ofHealth Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. audrey.laporte@utoronto.ca
Source
Health Econ Policy Law. 2008 Oct;3(Pt 4):393-411
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Adult
Aging
Canada
Cross-Sectional Studies
Female
Health Policy
Health Services - utilization
Humans
Male
Middle Aged
National Health Programs
Social Support
Abstract
This paper examines relationships between aging, social capital, and healthcare utilization. Cross-sectional data from the 2001 Canadian Community Health Survey and the Canadian Census are used to estimate a two-part model for both GP physicians (visits) and hospitalization (annual nights) focusing on the impact of community- (CSC) and individual-level social capital (ISC). Quantile regressions were also performed for GP visits. CSC is measured using the Petris Social Capital Index (PSCI) based on employment levels in religious and community-based organizations [NAICS 813XX] and ISC is based on self-reported connectedness to community. A higher CSC/lower ISC is associated with a lower propensity for GP visits/higher propensity for hospital utilization among seniors. The part-two (intensity model) results indicated that a one standard deviation increase (0.13%) in the PSCI index leads to an overall 5% decrease in GP visits and an annual offset in Canada of approximately $225 M. The ISC impact was smaller; however, neither measure was significant in the hospital intensity models. ISC mainly impacted the lower quantiles in which there was a positive association with GP utilization, while the impact of CSC was strongest in the middle quantiles. Each form of social capital likely operates through a different mechanism: ISC perhaps serves an enabling role by improving access (e.g. transportation services), while CSC serves to obviate some physician visits that may involve counseling/caring services most important to seniors. Policy implications of these results are discussed herein.
PubMed ID
18793479 View in PubMed
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Household responses to public home care programs.

https://arctichealth.org/en/permalink/ahliterature171079
Source
J Health Econ. 2006 Jul;25(4):674-701
Publication Type
Article
Date
Jul-2006
Author
Mark Stabile
Audrey Laporte
Peter C Coyte
Author Affiliation
Department of Economics, University of Toronto and NBER, 150 Street George Street, Toronto, Ont., Canada M5S 3G7. mark.stabile@utoronto.ca
Source
J Health Econ. 2006 Jul;25(4):674-701
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Decision Making
Family Characteristics
Home Care Services
Humans
Middle Aged
Models, Econometric
National Health Programs
Public Sector
Abstract
A choice-theoretic model of household decision-making with respect to care-giving time allocations and the use of publicly and privately financed home care services are proposed. Predictions concerning the effect of increased availability of publicly financed home care services on home care utilization, informal care giving, and health status are derived. These predictions are assessed through use of Canadian inter-provincial survey data on home care use and care giving that are matched with data on home care funding for the period 1992-1998. Increased availability of publicly financed home care is associated with an increase in its utilization, a decline in informal care giving, and an improvement in self-reported health status.
PubMed ID
16426689 View in PubMed
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Can a publicly funded home care system successfully allocate service based on perceived need rather than socioeconomic status? A Canadian experience.

https://arctichealth.org/en/permalink/ahliterature165258
Source
Health Soc Care Community. 2007 Mar;15(2):108-19
Publication Type
Article
Date
Mar-2007
Author
Audrey Laporte
Ruth Croxford
Peter C Coyte
Author Affiliation
Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. audrey.laporte@utoronto.ca
Source
Health Soc Care Community. 2007 Mar;15(2):108-19
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Catchment Area (Health)
Child
Child, Preschool
Databases as Topic
Female
Health services needs and demand
Home Care Services - economics - supply & distribution - utilization
Humans
Infant
Infant, Newborn
Insurance, Health
Long-Term Care - economics - utilization
Male
Middle Aged
National Health Programs
Ontario
Resource Allocation - economics - methods
Social Class
Abstract
The present quantitative study evaluates the degree to which socioeconomic status (SES), as opposed to perceived need, determines utilisation of publicly funded home care in Ontario, Canada. The Registered Persons Data Base of the Ontario Health Insurance Plan was used to identify the age, sex and place of residence for all Ontarians who had coverage for the complete calendar year 1998. Utilisation was characterised in two dimensions: (1) propensity - the probability that an individual received service, which was estimated using a multinomial logit equation; and (2) intensity - the amount of service received, conditional on receipt. Short- and long-term service intensity were modelled separately using ordinary least squares regression. Age, sex and co-morbidity were the best predictors (P
PubMed ID
17286672 View in PubMed
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How does complementary private prescription drug insurance coverage affect seniors' use of publicly funded medications?

https://arctichealth.org/en/permalink/ahliterature115289
Source
Health Policy. 2013 May;110(2-3):147-55
Publication Type
Article
Date
May-2013
Author
Sara Allin
Michael R Law
Audrey Laporte
Author Affiliation
School of Public Policy and Governance, University of Toronto, Canada. sara.allin@utoronto.ca
Source
Health Policy. 2013 May;110(2-3):147-55
Date
May-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Drug Costs - statistics & numerical data
Female
Financing, Government - economics - statistics & numerical data - utilization
Health status
Humans
Insurance, Pharmaceutical Services - economics - statistics & numerical data
Male
Ontario
Prescription Drugs - economics
Sex Factors
Socioeconomic Factors
Abstract
Like in many other high-income jurisdictions, the public drug program in Ontario, Canada provides comprehensive coverage of prescription drugs to the 65 years and older population with some cost sharing. The objective of this study was to examine the marginal impact of holding private drug coverage on the use of publicly funded medicines among the senior population in Ontario.
We drew on linked survey and administrative data sources to examine the impact of private drug coverage first on total spending and utilization of medications, and second, on clinically recommended medications for individuals with a diagnosis of diabetes.
Approximately 27% of Ontario seniors reported having private prescription drug insurance from a current or prior employer. The population-level analysis of all seniors found that individuals with private insurance coverage, on average, took about a quarter of an additional drug and incurred 16% more in costs to the public program in a year compared to those without additional coverage. The disease-specific analysis of seniors with a diagnosis of diabetes found that private coverage was associated with two-fold higher odds of taking an anti-hypertensive drug, but it had no association with the use of statins or anti-diabetic medications.
The results of this study provide some evidence that seniors in Ontario are sensitive to the price of drugs. These findings raise equity concerns relating to the cost sharing arrangements in the public system and our policy of allowing private plans to "top-up" the public plan.
PubMed ID
23522381 View in PubMed
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36 records – page 1 of 4.