Insurance In Canada Research Articles

Market Valuation of Bank Assets and Deposit Insurance in Canada

We examine a sample of Canadian banks and use option pricing theory to infer the market value of a bank's assets from the observed market value and volatility of its equity. We find that market value estimates are significantly different from corresponding book values. These differences vary significantly across banks, suggesting that market values provide bank-specific information not found in book values. We also derive that risk-adjusted deposit insurance premia for these banks. Our results suggest that the current fixed rate deposit insurance premium system has resulted in significant

Public health insurance: the collective purchase of individual care

Health insurance does not insure health. It reimburses the costs of health care, and enables potential users of care to pool their risks. But public health insurance is qualitatively different from private, in that risk pooling is not its only or even its primary function. Public systems also redistribute, deliberately, from low to high risk individuals. Perhaps even more important, public insurance is a mechanism for the collective purchase of care. It enables buyers, through their political representatives, to bargain with providers over both price and quantity of care, and thus to control overall system costs, in a way that individual patients cannot. This paper contrasts the experience of public insurance in Canada with private coverage in the U.S., to show how universal public coverage, used as a ‘collective purchasing agency’, has led to both better coverage and lower costs. Current policy changes in the U.S., described as ‘competitive’, are in fact efforts to create private collective purchasing agencies to bargain with providers on behalf of individuals. Yet economic analysis has been largely incapable of grasping this process, continuing to treat public and private insurance alike as simply reductions in the price of care faced by individual consumers, and thus generating erroneous predictions and analyses of the behaviour of public systems. It has encouraged a fruitless concern with the prices faced by patients, while ignoring the overwhelming significance of the structure and objectives of the insurer. This failure may be traceable to fundamental flaws in the concept of a transactor in economic theory.

Mortgage Rate Insurance in Canada

Mortgage Rate Insurance in Canada

Health care financing and the Canada Health Act.

This paper examines the argument that the Canada Health Act, 1984, repre development bysented the culmination of a policy the federal government which forced provincial governments to finance national health insurance programs without giving these governments the financial capacity to do so. Consideration of trends over the 1972-84 period suggests that the argument has not been valid historically, but that it might become so in the future, that the Canada Health Act was necessary to maintain the integrity of national health insurance in Canada.

Books Reviewed/Comptes rendus

Healthfulness of Life By R. Wilkins and O. Adams. Rebels, Rascals and Royally: The Colourful North of LAC0 Hunt Edited by Barbara Hunt Broadcasting Policy and Copyright Law: An Analysis of a Cable Rediffusion Right By Robeiit E. Babe and Conrad Winn. Social Democracy in Manitoba: A History of the CCF‐NDP By Nelson Wiseman. Policy Advice and Organizational Survival By Michael J. Prince. The False Promise of the Japanese Miracle By S.P. Sethi, N. Namikiand C.L. Swanson. Ethnic Pluralism and Public Policy: Achieving Equality in the United States and Britain By Nathan Glazierand Ken Young, eds. Economics of Poverty and Income Distribution By Morley Gunderson. National Health Insurance in Canada and Australia: A Comparative Political Economy Analysis Par Malcolm C. Brown

The Socialization of Medical Insurance in Canada

The Socialization of Medical Insurance in Canada

Male labor force participation and the social security disability program.

In an article in thisJournal, Parsons (1980a) analyzes the doubling in the rate of' nonparticipation in the labor force of older men since 1946. Using cross-sectional data from the National Longitudinal Survey (Parnes et al. 1970) in an index function model of the labor force participation decision, he tests the assertion that the withdrawal of older males is attributable to the rapid expansion of alternatives to work provided by the Social Security Disability Insurance (SSDI) program. He reports an elasticity of nonparticipation with respect to the replacement rate of' SSDI benefits of' .631 and concludes that the recent decline in labor force participation can be "largely explained by the increased generosity of' social welfare transfers, particularly Social Security disability payments" (p. 130). The magnitude of Parsons's estimate and its impact on the public debate over disability transfer policy require careful scrutiny of' its basis. In Section I, we describe Parsons's econometric model and construction of' variables; in Section II we provide a critique. In Section III, we test the robustness of Parsons's elasticity estimate by presenting alternative estimates based on corrections and extensions of his basic model. Section IV concludes.

The Inverse Care Law in the Context of Universal Free Health Insurance in Canada: Toward Meeting Health Needs through Social Policy

Abstract Canada's universal health insurance program, fully implemented in 1971 throughout the country, is considered by many to be a model system for the delivery of health services. Legislators believed at the time of its instigation that this program, through the removal of financial barriers, would increase access to needed medical services for Canada's population. Although great strides have been observed pre and post-implementation of this program, the available evidence suggests that the program has not succeeded completely in equalizing health outcomes. Selected evidence is presented and discussed in this regard, along with reasons why programs designed to equalize outcomes by equalizing access cannot necessarily respond to problems of structured inequality.

Book Reviews

Book reviewed in this article:NATIONAL HEALTH INSURANCE IN CANADA AND AUSTRALIA: A Comparative Political Economy Analysis. By Malcolm C. Brown. Canberra.WHY SO FEW? Women Academics in Australian Universities. By Bettina Cass.THE LONG FAREWELL: The Perilous Voyages of Settlers under Sail in the Great Migrations to Australia. By Don Charlwood.ARBITRATOR AT WORK: Sir William Raymond Kelly and the Regulation of Australian Industrial Relations. By Braham Dabscheck.NEW GUINEA UNDER THE GERMANS. By Stewart Firth.ALL THAT DIRT: Aborigines 1938. An Australian 1938 Monograph. Edited by Bill Gammage and Andrew Markus.FREDERICK WELD. By Jeanine Graham.THE REMARKABLE REVEREND CLARKE: The Life and Times of the Father of Australian Geology. By Elena Grainger.THE GLENNIE: A Work of Faith. By Christine Henderson.CONVICT SOCIETY AND ITS ENEMIES: A History of Early New South Wales. By J. B. Hirst.THE GREAT AUSTRALIAN NIGHTMARE: A Critique of Home‐ownership Ideology. By Jim Kemeny.PUBLIC SECTOR ADMINISTRATION: New Perspectives. Edited by Alexander Kouzmin.A NATION APART: Essays in Honour of Andrew Fabinyi. Personal Views of Australia in the Eighties. Edited by John McLaren.FOR LOVE OR MONEY: A Pictorial History of Women and Work in Australia. By Megan McMurchy, Margot Oliver and Jeni Thornley.AUSTRALIA'S CONSTITUTION: Time for Change? By John McMillan, Gareth Evans and Haddon Storey.AUSTRALIAN FEDERALISM: Future Tense. Edited by Allan Patience and Jeffrey Scott.SUB ROSA: Memoirs of an Australian Intelligence Analyst. By R. H. Mathams.PUBLIC SECTOR BORROWING IN AUSTRALIA. Edited by R. L. Mathews.MICRONATIONALIST MOVEMENTS IN PAPUA NEW GUINEA. Edited by R. J. May.THE FIRM AND THE FORMLESS: Religion and Identity in Aboriginal Australia. By Hans Mol.THE FIXED AND THE FICKLE: Religion and Identity in New Zealand. By Hans Mol.INTERNEE 1/5126. By Robert Paterson. Annerley, Queensland, Dr Robert Paterson, 1983.THE PHONE BOOK: The Future of Australia's Communications on the Line. By Ian Reinecke and Julianne Schultz.A HISTORY OF TASMANIA. Vol. I: Van Diemen's Land from the Earliest Times to 1855. By Lloyd.MINING AND AUSTRALIA. Edited by W. H. Richmond and P. C. Sharma.TRADE, TACTICS AND TERRITORY: Britain in the Pacific 1783–1823. By Margaret Steven.HEATHCOTE: A Study of Local Government and Resident Action in a Small Australian Town. By R. A. Wild.SOCIAL PROCESS AND THE CITY. Urban Studies Yearbook I. Edited by Peter Williams.SYDNEY'S TRANSPORT: Studies in Urban History. Edited by Garry Wotherspoon.ARMING THE CHINESE: The Western Armaments Trade in Warlord China, 1920–1928. By Anthony B. Chan.COLD WAR HOT WAR. An Australian Perspective on the Korean War. By Gavan McCormack.IMPERIALISMUS UND KOLONIALMISSION: Kaiserliches Deutschland und Koloniales Imperium. Edited by Klaus J. Bade, Weisbaden, Steiner Verlag, 1982.THE ISLAMIC THREAT TO THE SOVIET STATE: By Alexander Benningsen and Marie Broxup.ITALY AND THE APPROACH OF THE FIRST WORLD WAR. By Richard Bosworth.THE CRISIS OF MEDIEVAL RUSSIA 1200–1304. By John Fennell.THE STATE, FRANCE AND THE SIXTEENTH CENTURY. By Howell A. Lloyd.SOCIALISM AND EUROPEAN UNITY: The Dilemma of the Left in Britain and France. By Michael Newman.SOCIAL DEMOCRACY AND SOCIETY: Working‐class Radicalism in Diisseldorf, 1890–1920. By Mary Nolan.POLICY STYLES IN WESTERN EUROPE. Edited by Jeremy Richardson.IMAGES OF IMPERIAL RULE. By Hugh Ridley.THE EUROPEAN COMMUNITY: Past, Present and Future. Edited by Loukas Tsoukalis.NAZI PROPAGANDA: The Power and the Limitations. Edited by David Welch.THE UNOFFICIAL COMMONWEALTH: The Story of the Commonwealth Foundation, 1965–1980. By John.COVENANTS WITHOUT THE SWORD: Public Opinion and British Defence Policy 1931–1935. By Patrick Kyba.THE GREAT MAP OF MANKIND: British Perceptions of the World in the Age of Enlightenment. By P. J. Marshall and Glyndwr Williams.WHERE DID WE GO WRONG? Industrial Performance, Education and the Economy in Victorian Britain. Edited and introduced by Gordon Roderick and Michael Stephens.LOCAL GOVERNMENT: The Conditions of Local Choice. By John Stewart.THE ORIGINS OF THE SOCIAL DEMOCRATIC PARTY. By Noel Tracy.CHINESE MINE LABOUR IN THE TRANSVAAL. By Peter Richardson.POLITICAL ALTERNATIVES FOR SOUTHERN AFRICA: Principles and Perspectives. Edited by D. J. van Vuuren and D. J. Kriek.MAX WEBER ON CAPITALISM, BUREAUCRACY AND RELIGION: A Selection of Texts. Edited by Stanislav Andreski.MODERNISATION AND REVOLUTION. By Bill Brugger and Kate Hannan.A CRITIQUE OF FREEDOM AND EQUALITY. By John Charvet.THE MODERN LIBERAL THEORY OF MAN. By Gerald F. Gaus.FROM RIGHT TO LEFT: An Autobiography. By Frederick Vanderbilt Field.MAKING HISTORIES: Studies in History‐Writing and Politics. Edited by Richard Johnson, Gregor McLennan, Bill Schwarz and David.GUNBOAT DIPLOMACY 1895–1905: Great Power Pressure in Venezuela. By Miriam Hood.EDUCATED GUESSING: How to Cope in an Uncertain World. By Samuel Kotz and Donna F. Stroup.THE PURSUIT OF POWER: Technology, Armed Force, and Society since A. D. 1000. By William H. McNeill.LIBERAL DEMOCRATIC THEORY AND ITS CRITICS. Edited by Norman Wintrop.ORGANIZING INTERGOVERNMENTAL RELATIONS. By Timothy B. Woolstencroft.PUBLIC MONEY IN THE PRIVATE SECTOR: Industrial Assistance Policy and Canadian Federalism. By Allan Tupper.

Aspects of Medical Manpower under National Health Insurance in Canada

caGaGm ANAD A has had universal hospital insurance since 1961 S and universal medical care insurance since 1971. Medical care insurance was enacted: 1) as an inevitable consequence of universal hospital insurance, 2) because of its successfiul adoption in Saskatchewan, and 3) because the federal government accepted the recommendations of the 1964-1965 Royal Commission on Health Services (the Hall Commission) that it enact federal-provincial cost sharing for medical care insurance. In this paper we will examine the effect of universal medical care insurance on medical (and to a small extent nursing) manpower in Canada. We also will look at some of the current issues at the interface between governments and physicians. Although the analysis is national, health care in Canada is primarily a provincial responsibility and manpower policies are made at the provincial level. However, in the early days of universal medical insurance, federal contributions to the funding of medical education gave rise to a strong federal presence in medical manpower policy. Since the late 1970S, federal support of medical education and health care has decreased. With or without financial support of medical education at the federal level, medical manpower is a national resource in all of Canada except Quebec; licensure is donejointly by the nine anglophone provinces and movement of physicians among them is essentially unrestricted. In recommending universal medical care insurance in 1964-1965, the Hall Commission report made a number of assumptions (1): 1. The existing physician to population ratio of 1:857 was a minimum optimal ratio. This ratio had to be maintained or improved because of anticipated increased use due to unmet need and increased demand for services. 2. Population growth at existing rates would continue.

Universal Hospital and Medical Care Insurance in Canada: Utilization and Cost Performance

jra *n5LTHOUGH the Canadian provinces have constitu{ tional responsibility for hospital and medical care, a universal program was established in Canada when the federal government offered 5o/5o sharing of hospital and, later, medical care costs (1). The terms of reference 3*4t2X c!.A required to qualify for federal cost-sharing are broad, and there is variation among the ten provinces, particularly in the case of supplemental benefits. Under the new 1977 funding arrangements, even greater variation can be expected. The 50 /5o cost sharing was calculated to pay the poorer provinces more than half their costs and the wealthier provinces slightly less than half. Revenue sharing has been retained in the new 1977 fiscal arrangements. How has the system performed since 1958 when universal hospital insurance began, and since 1968 which marked the beginning of universal medical insurance? Despite initial concerns, the universal plans themselves did not result in persistent runaway utilization, although there were sharp increases in hospital spending between 1958 and 1961 and in medical care spending between 1968 and 1971. The universal plans in Canada were built on existing provincial insurance programs. In the case of hospital insurance, five provinces already had universal insurance when the Hospital and Diagnostic Services Act was adopted and implemented, and there were varying degrees of insurance in the other provinces. No persistent utilization effect can be demonstrated after the universal hospital insurance was adopted, but it may well be that any utilization effect had already been absorbed by the public and private health insurance which predated the universal plan. Per-capita admissions and patient days in general and allied special hospitals (acute-care hospitals) increased between 1% and 2% per year in the 1950S and 196os. Since 1970, patient days per 1,ooo population have fallen slightly. The decrease has

Equality in medical care under national health insurance in Montreal.

In November 1974, four years after national health insurance in Canada had eliminated all out-of-pocket payment for physicians' services, we surveyed 1559 households in a socially heterogeneous area of Montreal to assess social-class differences in the use of physicians' services. When reported health status as well as age and sex were taken into account, the rates of physician visits during the two-week period preceding the survey were essentially the same in the low, middle, and high economic classes, thus confirming that disparity of access had been reduced. However, relative to other groups, the poor still made considerable use of hospital clinics and emergency rooms for primary care and more of their visits entailed prescriptions and physician-initiated requests to return. The latter observations may indicate that the poor, as compared with other groups consulted the doctor for more advanced conditions. Official statistics showed no increase in the workload of the average physician, although the number of physician visits per person per year had risen steadily. There was no evidence of abuse of "free" medical care by the poor.

The Implications of Established Program Finance for National Health Insurance

The paper examines the implications which the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act, 1977, has for national health insurance in Canada. The Act not only reduces the amount of negotiation between the federal and provincial governments concerning health insurance 'standards' but also reduces the necessity for provincial governments bargaining with medical associations over the relation between fee schedules and extra-billing. It is plausible that this reduced bargaining, and consequently reduced public control, has contributed greatly to the development of user charges, which threaten the objectives and viability of the system.

Universal health insurance in Canada

This paper describes the universal health insurance program in Canada and identifies the historical events and social values leading to its adoption. Universal hospital insurance was adopted in 1958, ten years before medical insurance, as a result hospital-based patterns of practice were solidified. Through cost sharing, the federal government influenced the provinces to enact relatively uniform universal plans. From 1951 to 1971 health care expenditures rose rapidly to 7.3% of the gross national product (GNP), but have since decreased and stabilized at about 6.9%. In contrast, health care in the United States represents 8.6% of GNP. Hospital use also increased rapidly in Canada to 1970 but appears to have stabilized and decreased slightly in this decade. Physician incomes rose rapidly before 1971, but since then the increases have slowed and relative incomes of physicians have fallen. Althouth the percent of GNP spent for health care has leveled, there are still substantial annual increases in expenditures that are paid for by government. Two federal initiatives, Bill C-37 and the Lalonde Report, have their roots in cost containment; Bill C-37 transfers greater taxing authority from the federal government to the provinces. To meet the goal of containing costs, provincial governments are moving in the direction of regionalization, decentralization, and greater coordination. In the short term, the provinces have limited hospital budgetary increases to percentages less than the rate of inflation. Cost constraints may be long overdue. Imposing fiscal limits encourages rational planning. It does not appear that the health of Canadians will be adversely affected or essential benefits curtailed by present budgetary restrictions or reorganization.

Unemployment Insurance in Canada: A Review of the Recent Amendments

This paper summarizes available evidence on the impacts of the Canadian unemployment insurance program, discusses recent amendments to the program and proposes an alternative reform. It is argued that under 1978 conditions, the 'work disincentive' impact of UI Benefits on aggregate unemployment rates is quite small, hence cutting the benefit rate is unlikely to reduce appreciably measured unemployment (although it will increase the incidence of poverty). By altering the tax base of UI revenues, the amendments reduce its redistributive impact. On grounds of equity and efficiency it is argued that UI benefits should be taxed on a family income basis.

Some Effects of Health Insurance in Canada — From Private Enterprise toward Public Accountability

Ten years after the introduction of national medical insurance in Canada, it is possible to view the effect of a comprehensive health-insurance program on the relations among physicians, society and government. With costs of health care paid from the public rather than the private purse, provincial efforts to control the cost of hospital and physician services are increasing, and various methods for cost containment are now visible. Since the budget for these expenses is publicly debated it competes for support against other publicly funded programs. The federal/provincial insurance system is evolving as an instrument of reform in the organization of health services and has led to the introduction of legislation that is changing the health-delivery system. A gradual shift in power between various health agencies, physicians, professional organizations and government is occurring.

Managing the Public Sector. Automobile Insurance in Western Canada

Public automobile insurance programs in Saskatchewan, Manitoba, and British Columbia raise a number of questions of equity and efficiency. This paper examines the programs from several different viewpoints, comparing the actuarial categories, rate structures, and incentives in the public insurance provinces with those in Alberta. Suggestions are offered for improving the equity and efficiency of the programs. Questions of openness of information and organizational learning are discussed on the basis of Saskatchewan and Manitoba experiences. The New Democratic Party in the last few years has won elections in the Canadian provinces of Saskatchewan, Manitoba and British Columbia. These governments have been innovative in both the social welfare and insurance areas, following the example of Saskatchewan, where the Cooperative Commonwealth Federation, the NDPs predecessor, was first elected in 1944. The growth of the public sector and the problems and opportunities engendered by such expansion are not unique to Canada, but may have implications for the postindustrial society, both in North America and elsewhere.' Government-run automobile insurance was part of the platforms of both Manitoba and British Columbia NDP parties, and after their election (in 1969 and 1972 respectively), they moved to implement such programs. Because the British Columbia NDP was voted out of office in 1975, and the new Social Credit government raised insurance premiums dramatically, Leslie L. Roos, Jr., holds the Ph.D. degree from M.I.T. and is Professor, Faculty of Administrative Studies, University of Manitoba, Winnipeg. He is coauthor of Managers of Modernization (Harvard, 1971); Editor of The Politics of Ecosuicide (HoltRinehart-Winston, 1971); coeditor of Quasi-Experimental Approaches (Northwestern, 1971). He is currently involved in studies using the large data banks generated by National Health Insurance in Canada. An earlier version of this paper was presented at the 1975 meetings of the Canadian Association of Administrative Sciences, Edmonton, Alberta. The author thanks Elaine Recksiedler and Barb McKinley for their research assistance, as well as W. C. Gibson, Brian Owen, Ernie Vogt, John McCallum, and the anonymous reviewers for their valuable comments. 1 For a representative discussion of postindustrialism, see Daniel Bell, The Coming of the Post-Industrial Society (New York: Basic Books, 1973); Samuel P. Huntington, Postindustrial Politics: How Benign Will It Be? Comparative Politics, 6 (June 1974): 163-191; and Timothy M. Hennessey and B. Guy Peters, Postindustrialism and Public Policy. Paper presented at the Annual Meeting of the American Political Science Association, San Francisco, California, September 2-5, 1975.

Prepaid group practice under universal health insurance in Canada.

This paper describes the experience of the two prepaid group practice plans in Ontario before and after universal health insurance. Both plans were capitalized, before national health insurance, by member contributions and both have had persistent problems with enrollment constraints and professional opposition. The Sault Ste. Marie Plan began in 1963, six years before Canadian medicare. The plan was paid a capitation fee for medical services but did not share in savings from its reduced hospital use. After universal insurance sharing in decreased hospital use was offset by regulations which allowed plan members to use non-plan physicians at Plan expense. Payments to non-plan physicians now take up 20 per cent of Plan income. Active enrollment of members has been replaced by a Ministry of Health registration system which is based on overall utilization. The St. Catharine's Plan began at the same time as universal insurance in 1969. Its out-of-plan use averaged about 40 per cent of total income. Most recently this program has shifted from capitation to cost-reimbursement payment. In Canada present trends include cost containment, financing by general tax revenues rather than premiums and increased categorical benefits. Under Canadian universal health insurance prepaid group practice has an uncertain future.

No Fault Auto Insurance in Canada

The first action to provide limited automobile insurance benefits on a no fault basis occurred in Saskatchewan with passage of the Automobile Accident Insurance Act in 1946. The essence of the plan is its simplicity. It does not assure absolute justice to parties who would normally be plaintiffs and defendants in actions at common law. It does provide a type of average justice for all persons who might be injured as a result of motor car accidents and attempts to provide this justice speedily and economically. Through a schedule of accident benefit payments, compensation is available to all motor accident victims regardless of fault but no attempt is made to prevent such persons from taking legal action to recover additional amounts claimed from a defendant. This first scheme was initiated not because of delays in the existing insurance system but rather because only 10 percent of the automobile owners at that time carried liability insurance. As a result, persons who have been continuous residents of Saskatchewan since 1946 have had no experience with what was considered normal automobile insurance coverage in other jurisdictions. It should also be noted that Saskatchewan has a population of less than 1,000,000 and the lowest automobile traffic density in North

A Canadian View of Life Insurance

My appearance before you today calls for a mixture of pleasure and trepidation. It is not every day that I have the honour of addressing a learned society but as I have reviewed articles in your Journal I realize your society is concerned with risks so I presume you have made a calculated risk in selecting me as a speaker. Your Association is making a very valuable contribution to the understanding and to the science of insurance and I wish that in Canada we had universities which offered broad courses in insurance and more professors who made a serious study of insurance. This luncheon is in honour of your Past Presidents. May I say that reading a list of your Past Presidents is like reading the names from an insurance Hall of Fame. They are indeed a distinguished group. The reputation of many of them extends well beyond the United States. I join my fellow Canadians in welcoming you to our country on this the first meeting of your Association outside of the United States. I am sure you will enjoy your visit in Canada. It is my intention to comment briefly on life insurance in Canada, and where appropriate, to contrast developments here with those in the United States. Life insurance in Canada is a major financial institution and one of Canada's most important exports. Approximately 30