Working Papers

Dreaming of a Brighter Future? The Impact of Economic Vulnerability on University Aspirations (with Nancy Kong & Shelley Phipps)

Abstract: We examine whether there is an inequality of opportunity to achieve higher education, partially explained by aspirations for youth age 12-15 in economically vulnerable households. Using a unique Canadian dataset (2002-2008), we find that poverty is associated with reduced university aspirations from the perspective of the youth and their mother. Further, poverty depth matters less than incidence. In terms of magnitude, poverty contributes to about 10-15 percent of the observed inequality of opportunity gap (mother's education being the largest factor at 30 percent). Interestingly, economic insecurity is not associated with educational aspirations, and this result persists regardless of how we measure insecurity. Controls for academic effort, including standardized test scores, daily reading, and getting good grades do not impact these findings. Results therefore suggest that alleviating child poverty and easing post-secondary financial barriers among the poor, may help offset reduced university aspirations at a critical time in a youth's life.

The impact of capitation on health insurance membership and the provision of care in Ghana (with Bintu Bayong)

Abstract: To address escalating health care costs, in 2012, the National Health Insurance Authority (NHIA) for Ghana piloted a capitation model in the Ashanti region. Employing a difference-in-differences strategy, we use district-level data from 2010-2014 to examine the impact capitation had on health insurance membership and the associated provision of care. Findings suggest that, relative to control districts, capitation reduced membership by 39 percent, putting downward pressure on total outpatient department (OPD) usage (falling 48 percent) and cost (falling 38 percent). However, in per-member terms, neither OPD usage, nor cost, changed during this period - i.e., cost savings were the result of declining renewals. When observing each year of capitation, per-member cost rebounded in 2013 after an initial 34 percent decline, however, per-member usage did not deviate from pre-capitation levels. Additionally, there appears to have been a cost-shift in that capitation produced rising inpatient department cost - an avenue not affected by capitation - at both the total (29 percent) and per-member (68 percent) level. Lastly, although premium exempt, capitation particularly reduced membership among the poor. Thus, future policies should be cognisant of declining membership, incentives for cost increases and cost-shifting, along with the potential inequitable impacts of capitation.

An Examination of Health Care Efficiency in Canada: A Two-Stage Semi-Parametric Approach (with Gholam Amin)

Abstract: Using data envelopment analysis, we examine the efficiency of Canada’s universal health care system by considering a set of labour (physicians) and capital (beds) inputs which produce a level of health (in terms of quality and quantity) in a given region. Data from 2013-2015 were collected from the Canadian Institute for Health information regarding inputs and from the Canadian Community Health Survey and Statistics Canada regarding our output variables, health utility (quality) and life expectancy (quantity). We posit that the variation in efficiency scores across Canada are the result of demand-side factors, particularly with respect to regional heterogeneity regarding socioeconomic and demographic disparities. Regressing efficiency scores on such covariates suggests that regional unemployment and an older population are quite impactful and associated with less efficient health production. Moreover, regional variation indicates the Atlantic provinces (Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick) are quite inefficient, have poorer economic prospects, and tend to have an older population than the rest of Canada. Oaxaca-Blinder decompositions suggest that the latter two demand-side factors explain about one-third of this efficiency gap. Based on our two-stage semi-parametric analysis, we recommend Canada adjust health transfer payments to reflect these disparities, thereby reducing inequality in regional efficiency.