Accounting for the Rising Caesarean Section Rate in Canada: What Are the Roles of Changing Needs, Practices, and Incentives?

In most high-income countries, including Canada, the share of births by Caesarean section (C‑section) has risen over the past decades to far exceed World Health Organization recommendations of the proportion justified on medical grounds (15 percent). Although unnecessary C-sections represent an important cost for health care systems, they are not associated with clear benefits for the mother and the child and can sometimes represent additional risks. Drawing on administrative records of nearly four million births in Canada, as well as macro data from the United States and Australia, we provide a comprehensive account of rising C-section rates. We explicitly consider the contributions of the main factors brought forward in the policy literature, including changing characteristics of mothers, births, and physicians as well as changing financial incentives for C-section deliveries. These factors account for at most one-half of the increase in C-section rates. The majority of the remaining increase in C-sections over the period 1994–2011 occurred in the early 2000s. We suggest that some event or shock in the early 2000s is likely the primary determinant of the recent strong increase in the C-section rate in Canada.

A Pervasive Economic Fallacy in Assessing the Cost of Public Funds

In the assessment of the cost of public funds, there is a pervasive economic fallacy that is frequently repeated in public policy circles: because the cost of borrowing is higher for a private-sector firm than it is for a public-sector firm, the cost of carrying out an activity (investment, production, distribution, provision of goods and services, and borrowing) will necessarily be lower ceteris paribus in the public sector than in the private sector. The statement is erroneous because part of the government’s cost of borrowing, namely the risk borne by citizens, customers, and taxpayers, is hidden from the casual observer of market interest rates or yields. The all-inclusive borrowing cost, more generally the all-inclusive cost of capital, is the same for both the public and the private sectors. I discuss four specific real cases in which the error is present: the Quebec Generations Fund, the Québec CDPQ Infra–Réseu express métropolitain project, the Infrastructure Ontario methodology to assess the riskiness of costs, and the BC Hydro Site C hydroelectric megaproject. I also discuss a general fifth case, namely government support programs for businesses (grants, loans, guarantees, subsidies, etc.), which are generally justified on the fallacious claim that the cost of financing is lower for the government than for the private sector. I propose an auction process by which the true cost of business support programs could be made transparent. I conclude with an appeal for a more rigorous use and management of public funds because miscalculation, misinformation, mismanagement, and fallacious analysis will eventually backfire.

Debt, Financial Vulnerability, and Repayment Behaviour in Older Canadian Households

Earlier research has documented that debt at older ages has increased significantly in Canada over the period from 1999 to 2016. In this article, we explore the consequences of a growing proportion of older Canadian households experiencing financial vulnerability. After controlling for household characteristics, we find among older households that a high debt-to-asset ratio and very low liquid wealth are significantly and positively associated with skipping or delaying a mortgage or non-mortgage debt payment and with usually paying the minimum amount or less on credit cards in the previous year. The debt-to-income ratio, however, is not an important indicator of financial vulnerability for older households.

Une évaluation de l’effet du crédit d’impôt pour prolongation de carrière sur l’emploi et le taux d’activité des travailleurs de 60 ans et plus au Québec

En 2012, le gouvernement du Québec, à l’instar de la Suède et de l’Australie qui l’avaient précédé, mettait en place le Crédit d’impôt pour les travailleurs d’expérience afin d’inciter les travailleurs âgés à demeurer ou à revenir sur le marché du travail. Ce programme est devenu le Crédit d’impôt pour prolongation de carrière (CIPC) en 2019. Le présent article évalue l’effet de ce crédit d’impôt sur le taux d’activité et d’emploi des travailleurs âgés par la méthode des différences dans les différences, en s’appuyant sur les microdonnées à grande diffusion de l’ Enquête sur la population active de Statistique Canada et en prenant l’Ontario comme groupe de référence. L’analyse probit indique un effet positif et significatif du CIPC sur la probabilité d’emploi ou d’activité dans la plupart des sous-groupes d’âge et de sexe des personnes de 60 ans et plus. Au total, sur la période de 2012 à 2019, les auteurs estiment que cette politique a contribué à maintenir ou à combler un peu moins de 27 000 emplois en moyenne par année chez les 60 ans et plus, à un coût annuel moyen de 4 800 $ par emploi, ce qui place le Québec dans une position avantageuse par rapport à des pays qui ont adopté des politiques semblables. Ainsi, un programme qui cible les classes d’âge et de revenu peut améliorer significativement la performance de cet outil fiscal.

Estimating the Economic Impacts of Specific Claims Settlements in Canada: The Case of Little Red River Cree Nation

Since 1973, 535 specific claims valued at more than $6 billion have been settled between the Government of Canada and First Nations governments for outstanding treaty obligations. Critics of specific land claims point to the absence of statistical evidence that shows a positive impact on First Nations economies and characterize specific claims as a multi-billion-dollar liability for Canadian taxpayers. This research shows that the economic benefits of specific claims are being lost to First Nations economies through high rates of economic leakage, especially in cases in which large proportions of the settlement funds are disbursed on a per capita basis. Collaborating with the Little Red River Cree Nation (LRRCN) in Alberta (a recent recipient of a $239 million settlement), we use household expenditure data, band-owned businesses’ financial statements, and band administration audit reports to estimate their rate of economic leakage and the economic impact of their specific claims settlement. Results indicate that the economic leakage rate for the LRRCN is 83.5 percent. Using household expenditure data and input–output models, we estimate the economic impact of the LRRCN settlement. Assuming a 100 percent per capita disbursal of the funds, the settlement would contribute $275–$339 million in provincial output, $172–$212 million in gross domestic product, and $110–$127 billion in labour income, and it would create 2,393–2,714 full-time jobs. The results of this research may be of value to First Nations leaders in making decisions concerning the distribution and investment of specific claims settlements in the future.

What Happened to the Immigrant Life Satisfaction Gap?

Numerous studies have found that immigrants to Canada are less satisfied with life than comparable Canadian-born individuals. Yet recent data from the Canadian Community Health Survey (CCHS) suggest that this immigrant satisfaction gap may be disappearing. This article traces the evolution of the immigrant–Canadian born life satisfaction gap from 2009 to 2018 and explores two competing explanations for the declining gap: improved immigrant outcomes and changes to the CCHS design introduced in 2015–2016. The article finds little evidence for the improved outcomes explanation. Indeed, the immigrant satisfaction gap is somewhat illusory—the more substantial gap is between the life satisfaction of White individuals and that of members of certain racialized groups, regardless of immigration status. The 2015–2016 CCHS redesign, however, may be a plausible explanation for the increase in reported life satisfaction. This article provides more evidence that researchers using life satisfaction measures need to be cautious when survey designs change.

How Did the Canada Child Benefit Affect Household Spending?

We assess how the July 2016 increase in the Canada Child Benefit (CCB) affected household spending with respect to total current expenditure and its seven constituent categories: clothing, food, health care, household operations, recreation, shelter, and transportation. The increase in the CCB was large: for most recipient households, it increased by more than $2,000 per child per year. We consider households below the median income level and find statistically significant effects of the policy change only for spending on clothing, food, and shelter and only for rental-tenure households. We find that rental-tenure households with children that fell below the median income level increased their annual expenditure by about $3,400 in response to the CCB increase. Spending on food increased by roughly $700; spending on shelter, by nearly $1,400. Spending on clothing increased by roughly $350, but spending mainly increased on children’s clothing, not on adults’ clothing.

Evaluating Foreign Skills: Effects of Credential Assessment on Skilled Immigrants’ Labour Market Performance in Canada

Formal educational qualification is increasingly built into immigrant selection systems in many countries, but in a global context, the transferability and portability of such qualifications has been questioned. In 2013, Canada introduced the requirement for a formal assessment of educational credential equivalence for applicants in the skilled worker category. In this study, we use a Canadian national immigration database and difference-in-differences methodology to investigate whether requiring formal Educational Credential Assessment (ECA) as part of the selection process for skilled immigrants has improved labour market outcomes. Our results indicate that the ECA requirement is positively related to early employment rates and earnings for both men and women. However, this effect is limited to those with no previous employment experience in Canada. We also find that, even with the ECA requirement, significant differences in the earnings of immigrants from different source regions remain. Implications and recommendations are discussed.

Assessing the Removal of Regional Health Authorities in Ontario

A little more than a decade ago, a series of regional bodies were introduced throughout Ontario to help resolve difficulties with the province’s health care system. The Local Health Integration Networks, the name given to the new health entities, sought to create a connected set of health services and to achieve more effective control and distribution of health care finances. A third intent was to engage the community when setting priorities for health care. Recently, the new government of Ontario replaced the LHINs with a single health authority. It asserted that the single authority was better equipped to handle the many problems that still prevailed. An assessment of this decision offers some grounds for disbanding the LHINs. However, the findings offer stronger support for the alternative of keeping the regional authorities and providing them with greater autonomy.