The Fiscal Sustainability of Alberta's Public Health Care System

From 1975 to 2007, Alberta’s real per capita government health expenditures grew from $1,679 to$3,696 (in 2007 dollars), at a median annual growth rate of 3.5%. Over the same period, Alberta’s real per capita gross domestic product and real per capita total government revenues grew at median annual rates of 2.2% and 1.7%, respectively. This difference between the growth rates of health care spending on the one hand and government revenues and the economy on the other gives rise to concern about the fiscal sustainability of the province’s public health care system.This study presents projections of real per capita spending on public health care in Alberta over the medium term out to 2030. They suggest that, by then, real per capita spending could reach anywhere between $5,339 and$14,215, soaking up between 32% and 87% of total government revenues; more worrying, the high end of these ranges reflects a continuation of the policy settings that guide current provincial public health spending. Alberta is fortunate to have a wealthy economy that can support a high level of public health spending. But that support is precarious given the cyclical nature of non-renewable natural resource revenues and Alberta’s past tendency to experience periods of boom and bust. Basing the financing of key spending programs such as health care on a volatile revenue base is not advisable, for it puts them at risk should economic conditions turn unfavourable, as they have recently. Indeed, adjusting government revenues in our projections to match a more reasonable measure of what might be relied upon with a degree of certainty simply enhances the precariousness of the fiscal sustainability of the public health care system.Not all categories of provincial government health care spending — in particular, the traditional core medicare areas of physician services and hospitals — are growing faster than either the revenue base or the economy. The growth of spending on non-medicare categories such as drugs, capital, and all other health expenditures, however, is a particular source of concern.Options for sustaining provincial government health expenditures include choosing what other government programs could be allowed to grow more slowly over time, what tax rates could be increased to cause the revenue base to grow more quickly, and what health programs currently provided by the public sector instead could be provided privately. These approaches need not exist in watertight compartments, however, and a portfolio of policies that combines these solutions likely would be a pragmatic policy outcome. Such a strategy would help to ensure the fiscal sustainability of Alberta’s public health care system and responsibly provide for the future welfare of its citizens

Wealth and Inequality on Ontario’s Northwestern Frontier: Evidence from Probate

This study examines a unique data set of 1,293 estates from probate records of the Thunder Bay District Surrogate Court for the period from 1885 to 1920. The data document a period of sustained growth spanning the years 1885 to 1906, an intense boom over the period from 1907 to 1913, and a post-boom “bust” over the years 1914 to 1920. Real average wealth in 1900 dollars during the boom period (1907– 1913) was almost 112 per cent higher than it had been in the previous period and approximately 95 per cent greater than during the post-1913 period. The boom was accompanied by a massive increase in wealth inequality, as the share of the top 10 per cent of wealth-holders rose from 66 to 75 per cent. While the average increases in wealth during the boom were greatest among the top fifth of wealth-holders, this group also sustained the greatest declines in wealth during the post-boom collapse. In addition, the post-boom collapse appears to have harmed women’s wealth-holding proportionately more than men’s, perhaps because of the greater propensity of women to hold their wealth in the form of mortgages.Cette étude s’intéresse à un ensemble unique de données portant sur 1 293 successions homologuées par le tribunal successoral de district de Thunder Bay de 1885 à 1920. Les données font état d’une période de croissance soutenue de 1885 à 1906, d’un boom intense de 1907 à 1913 et d’un effondrement écho boom de 1914 à 1920. Durant le boom (1907–1913), la valeur réelle moyenne du patrimoine, mesurée en dollars de 1900, était de près de 112 p. 100 plus élevée qu’au cours de la période précédente et d’environ 95 p. 100 plus forte qu’après 1913. L’écart de richesse s’est profondément creusé durant le boom, la part des 10 p. 100 les plus riches étant passée de 66 à 75 p. 100. Si le patrimoine du cinquième des mieux nantis s’est en moyenne le plus accru durant le boom, il a également diminué le plus durant l’effondrement qui a suivi. De plus, l’effondrement écho boom semble avoir frappé, toutes proportions gardées, plus durement les femmes que les hommes, peut-être parce que celles-ci étaient davantage portées à conserver leur patrimoine sous forme d’hypothèques

Cross-border Trips by Canadians and Americans and the Differential Impact of the Border

Same day automobile trips have been used as a barometer of cross-border shopping between Canada and the United States. The determinants of same day automobile crossborder trips by Canadians and Americans are examined using regression analysis and the results find that key determinants are lagged trips, per capita income, the real exchange rate and seasonal factors. The coefficient on lagged trips is larger for Canada than for the United States suggesting that, over time, Canadians adjust more rapidly to the desired number of trips than Americans. More intriguing is the fact that while income is positive for Canadian same day auto trips to the United States, it is negative for American same day auto trips to Canada. This implies that cross-border trips are normal goods for Canadians but inferior goods for Americans. The Canada-U.S. border is thus viewed differently by residents depending on which side they happen to live on and exercises a differential impact on cross-border trips

Cross-border Trips by Canadians and Americans and the Differential Impact of the Border

Same day automobile trips have been used as a barometer of cross-border shopping between Canada and the United States. The determinants of same day automobile crossborder trips by Canadians and Americans are examined using regression analysis and the results find that key determinants are lagged trips, per capita income, the real exchange rate and seasonal factors. The coefficient on lagged trips is larger for Canada than for the United States suggesting that, over time, Canadians adjust more rapidly to the desired number of trips than Americans. More intriguing is the fact that while income is positive for Canadian same day auto trips to the United States, it is negative for American same day auto trips to Canada. This implies that cross-border trips are normal goods for Canadians but inferior goods for Americans. The Canada-U.S. border is thus viewed differently by residents depending on which side they happen to live on and exercises a differential impact on cross-border trips

Patterns and Determinants of Wealth among Probated Decedents in Wentworth County, Ontario, 1872-1902

A micro-data set, comprised of 405 decedents in Wentworth County, Ontario, between 1872 and 1902, was constructed from probate, census, and tax assessment records. The data are analysed for evidence pertaining to patterns of wealth-holding and to various issues in the social and economic history of late Victorian Ontario. In general, wealth increased among decedents who were female, native-born, rural dwellers, Catholic, farmers, and of high occupational status. The average wealth of decedents who were urban dwellers, of low occupational status, and Protestant decreased. The analysis indicates the presence of two motives for saving: to provide bequests for children and to save for an independent old age, without the need to rely on children for support. This suggests that a transition was taking place in Wentworth County from an old-age security system based on family obligations to one based on market relationships.Un ensemble de microdonnées sur 405 personnes décédées entre 1872 et 1902 dans le comté de Wentworth, en Ontario, a été construit à partir de documents de succession, de recensement et d’évaluation foncière. Les données sont analysées pour trouver des preuves sur les tendances de la possession de la richesse et diverses questions touchant l’histoire sociale et économique de l’Ontario de la fin de l’époque victorienne. En général, la richesse augmentait chez les défunts de sexe féminin, de souche, ruraux, catholiques, fermiers et de statut professionnel élevé. La richesse moyenne diminuait chez les défunts urbains, de faible statut professionnel et protestants. Selon l’analyse, il y avait deux motifs d’épargne : donner un legs aux enfants et se préparer une vieillesse autonome, indépendante du soutien des enfants. Cela tend à montrer que l’on passait, dans le comté de Wentworth, d’un système de sécurité de la vieillesse basé sur les obligations familiales à un système basé sur les relations de marché

Spend Less, Get More? Explaining Health Spending and Outcome Differences Between Canada and Italy

Canada spends more than Italy on health per capita and as a share of GDP and has a higher per capita GDP.  Yet, life expectancy and infant mortality in Italy are better and have improved more over time.  The implication is that the Italian health care system provides better value for money.  We examine whether Italy does get better health outcomes at lower costs. Using regression analysis, we find that health spending is determined by similar drivers in both Canada and Italy.  We also find that more social spending and health spending in either country do not satisfactorily explain the differences in health outcomes, suggesting the importance of broader socio-economic determinants like income and life-style choices.  We conclude that while the levels of per capita health spending in Canada are higher than Italy, this partly reflects historical inertia in Canadian health spending partially attributable to the higher costs of health professionals relative to Italy

Economic Growth and the Public Sector: A Comparison of Canada and Italy, 1870-2013

There is considerable evidence that the size of the public sector can influence an economy’s rate of economic growth. We investigate public sector spending of central governments and economic performance in two G7 countries over the long-term, Canada and Italy. Their economic performance has diverged in the last 25 years and it is worth investigating whether the size of government was a contributing factor. We find that in both the case of Canada and Italy the size of central government spending directly affects the performance of their economies in an inverse U-shaped relationship known as a Scully/BARS Curve. These results suggest that along with modifying current central government size, other levels of governments may need to shrink their own spending. The fact that the amount spent by government on pensions as a percentage of GDP in Italy is nearly 4 times that in Canada may partly explain the higher level of Italy’s public debt as well as an indirect contributing factor to economic stagnation in the last 25 years

The Determinants of Public Health Expenditures: Comparing Canada and Spain

The determinants of public health care expenditure are examined in two of the most decentralized countries in the world (Canada and Spain) for two partly overlapping time-spans of data availability: Canada, 1981 to 2013 and Spain, 2002 to 2013. While Canada generally spends more per capita on health care than Spain, over time Spain’s macro level health indicator performance has surpassed Canada’s. Using regression analysis, we find the key determinants of public health care spending include time trend, income, physician numbers and regional fixed effects. Physician numbers are a significant driver of real per capita public health expenditures in Canada but not Spain despite the greater per capita number of physicians in Spain. Differences in the growth and performance of real per capita income explain much of the gap between public health spending between these two countries with some contribution from differences in per capita physician numbers. The differential health indicator outcomes raise the question of what Canada might do to be more efficient

The Determinants of Public Health Expenditures: Comparing Canada and Spain

The determinants of public health care expenditure are examined in two of the most decentralized countries in the world (Canada and Spain) for two partly overlapping time-spans of data availability: Canada, 1981 to 2013 and Spain, 2002 to 2013. While Canada generally spends more per capita on health care than Spain, over time Spain’s macro level health indicator performance has surpassed Canada’s. Using regression analysis, we find the key determinants of public health care spending include time trend, income, physician numbers and regional fixed effects. Physician numbers are a significant driver of real per capita public health expenditures in Canada but not Spain despite the greater per capita number of physicians in Spain. Differences in the growth and performance of real per capita income explain much of the gap between public health spending between these two countries with some contribution from differences in per capita physician numbers. The differential health indicator outcomes raise the question of what Canada might do to be more efficient