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Copyright of Canadian Water Resources Journal / Revue Canadienne des Ressources Hydriques is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. Methods: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. Results: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. Conclusion: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site. [ABSTRACT FROM AUTHOR]

Quigley derived his hybrid price model to improve the precision of predicted prices of sold homes by statistically merging data of resold homes in a repeat sales model with that of once-sold homes in a single sales hedonic price model. The literature has few applications of the hybrid model aside from those by Quigley and his collaborators. Two reasons for this underuse may be its computational intensiveness and its marginal empirical improvement in comparison with two other models. This paper first demystifies this computational intensiveness by calibrating models in Microsoft Excel with transferable procedures into other software. It second evaluates the hybrid price model’s empirical improvement as a reason for its underuse by predicting prices of 2,559 sold and resold homes observed in two inner-city neighbourhoods in Windsor, Ontario, during a 30-year period. The results as hypothesized are its lower standard errors of regression coefficients and higher simple R-squared than those of a single sales hedonic price model. Moreover, the hybrid model’s predictions have higher correlations than those of the single sales model with not only in-sample observed prices or changes in prices but also out-of-sample ones. The conclusion speculates in plans for future research about reasons for two models’ similar or dissimilar regression coefficients and standard errors predicting correspondingly similar or dissimilar sale prices of homes through time. [ABSTRACT FROM AUTHOR]

Michel Callon's economic sociology frequently addresses the topic of disability. Though his Actor-Network Theory (ANT) contributions are often cited within mainstream disability studies, his economic sociology has not. In this paper, I seek to present it to disability studies, and argue that it is complimentary to existing inquiries into the political economy of disablement. After sketching out ANT and Callon's economic sociology, which I read as part of the ANT tradition, I apply them to the case of the Ontario Disability Support Program's (ODSP) Employment Supports. This ODSP program seeks to include disabled Ontarians in the labor market. It also offers us the opportunity to examine the utility of Callon's work. I conclude with a discussion of future Callon-inspired disability studies. [ABSTRACT FROM AUTHOR]

Declining student enrolment is a phenomenon being faced by many school authorities throughout Canada. This is particularly important for policymakers since governments provide the bulk of education funding on a per pupil basis. In jurisdictions across Ontario, where population demographics and economic factors negatively impact enrolment, the influence on education services can be dramatic. The purpose of this paper is to assess and to explore past and present policy responses to demographic change and to discuss ways policymakers can mitigate the adverse impacts of declining enrolment. [ABSTRACT FROM AUTHOR]

While strict agricultural zoning policies, or greenbelts, are implemented to reduce urban sprawl, such policies may result in the leapfrog effect, which could cause sprawl to extend further . This paper outlines a theoretical explanation for the occurrence of the leapfrog effect due to development restrictions imposed by agricultural zoning. This theory is then applied empirically to a setting where agricultural zoning has been implemented: Ontario's Greenbelt. The results provide evidence that the leap-frog effect has occurred around the Greenbelt, as farmland values just beyond the outer boundary have increased. Extensive sensitivity analysis supports this result. [ABSTRACT FROM AUTHOR]

In this paper, we investigate toll setting as a policy tool to regulate the use of roads for dangerous goods shipments. We propose a mathematical formulation as well as a solution method for the hazardous materials toll problem. Based on a comparative analysis of proposed mathematical models, we show that toll policies can be more effective than the popular network design policies that identify road segments to be closed for vehicles carrying hazardous materials. We present a summary of computational experiments on a problem instance from Western Ontario, Canada. [ABSTRACT FROM AUTHOR]

This paper examines the short-lived electricity sector restructuring initiative of the province of Ontario, Canada's largest province. In May 2002, following years of planning and consultation Ontario opened its retail and wholesale electricity markets to competition. The summer of 2002 saw retail prices reach levels that consumers had never previously encountered. By December 2002, the provincial government froze retail electricity prices, covering approximately half of Ontario's electricity consumption. While the weather played a significant role in driving prices higher during the summer of 2002, other factors also played a major role. The other factors reviewed in this paper fall into two categories. The first category consists of market design problems, such as market rules (e.g., trading arrangements) and market structure (e.g., the degree of competition in the generation sector). The second category covers political economy problems, in particular the lack of political will to allow retail prices to reflect wholesale prices and to address effectively structural problems in the sector. Finally, this paper examines some of the new restructuring initiatives being pursued by the recently elected provincial government of Ontario as the province continues to struggle to bring order to its electricity sector. [ABSTRACT FROM AUTHOR]

Introduction: Despite the lack of evidence supporting its practice, antipsychotic polypharmacy (APP), is widely used1,2,3,. To change the outcomes that are directly related to doctors' decisions, it is important to understand the decision-making process and the factors which affect it. Behavioral Economics is a field that blends social psychology and economics, and it seeks to understand how biases affecting the human decision-making process. Strategies based on Behavioral Economics principles have been successful in addressing many issues in healthcare. This paper describes a quality improvement project designed with the aim of reducing APP prescribing behavior in a large psychiatric hospital in Brazil. Aims Objectives Theory or Methods: Nineteen units participated in this case study. The intervention targeted all prescribers and it involved the use of norms and peer comparison, behavioral economics principles which indicate that individuals are more likely to adjust their behavior if they perform below the average performance of their peers. After baseline, where the APP prescribing rate for the whole hospital and for each unit in particular were assessed, a weekly email was sent to each prescriber with information about the hospital-wide APP prescribing rate, feedback related to the APP prescribing rates in their units, and how they compared to other units. Highlights or Results or Key Findings: The intervention was successful in reducing hospital-wide APP prescribing rate. After the second e-mail, we observed a steep drop in the APP prescribing rate, and the rate never returned to preintervention levels. The weekly emails with feedback and peer comparisons yielded an average statistically significant difference of about 8.02% (t(10) = 4.7491, p < 0.008) over a brief 11-week period. This study demonstrated that e-mails designed according to a Behavioral Economics strategy can affect prescribing behavior. Conclusions: Information about the lack of evidence for the use of antipsychotic combinations, about the rates in other parts of the world, and information about the rates in hospitals with a similar population within their own state was enough to yield statistically significant results.. Implications for applicability/transferability sustainability and limitations: Future quality improvement projects targeting prescribing behavior should consider a combined use of guidelines and training with norms and peer comparison. [ABSTRACT FROM AUTHOR]

Background: Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends).Methods/design: The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration.Discussion: This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap.Trial Registration: ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014. [ABSTRACT FROM AUTHOR]

Discusses the reactions to the old and new institutional economists at the June 1989 History of Economics Conference in Toronto, Ontario. Significant issue in the Toronto conference; Information on the papers presented in the conference; Observation on Langlois' admission on old and new institutional economists.

Presents information on the results of an experiment which identified the factors accounting for student performance in the introductory economics course of Queen's University in Kingston, Ontario in 1971-1972. Average test scores of the students who took the course; Evaluation of the economic knowledge of the students six years later; Analyses of the results.

This paper presents a case study of the outsourcing of IT services between 1996 and 2003 by the Government of Ontario using a Public Private Partnership (P3) as an example of the commodification of public services including the impact on labour. It argues that three key features of the arrangement led to it becoming an 'unequal partnership.' First, ideological notions of a 'knowledge economy' and the techno-wizard status of independent IT workers were used by IT corporations to charge very high corporate rates for the time of outsourced IT staff, despite the fact that they were in fact undergoing a process of proletarianisation. Second, the P3 cost-benefit structure of shared costs and shared payments provided the framework for corporate partners to realise higher profits from investment in privatised state activities. Third, the explicit support of influential state and near-state actors undermined opposition to P3 projects. [ABSTRACT FROM AUTHOR]

Background: The primary purpose of this exploratory autism research was to examine the lived experiences of female primary caregivers of children with an autism spectrum disorder (ASD). Methods: Specifically the costs and benefits of the primary caregivers' experiences were examined through semi-structured one-one-one interviews. The specific focus of this paper was to examine the costs of caring for a child with an ASD, whereby costs did not refer solely to monetary costs, but were related to all aspects of the caregivers' lives. Interviews were completed with 8 mothers of children that had been formally diagnosed with an ASD. Results: Undoubtedly all family members within the family unit were affected by a child's diagnosis with ASD as evidenced by the costs revealed by mothers. The subthemes derived from the theme of costs included the following: financial and work costs, costs to the health of family, social costs, and costs to overall family life. The results from this research provide evidence of the challenges associated with caring for a child with an ASD. Conclusions: It is anticipated that the insights provided by these mothers can act as a source of support for others faced with a similar situation. Additionally health care professionals may be able to use the knowledge gained from such qualitative endeavors in order to help parents cope more effectively with their caregiving responsibilities associated with children with ASDs. The mothers within this study are remarkable women that, for the most part, were able to rise above the negatives/costs associated with caring for a child with an ASD and find the silver linings amidst the turmoil. As remarkable as these women are in the daily struggles they face with their children, it is evident that more resources and support are required to assist these women and their families. [ABSTRACT FROM AUTHOR]

Since the late 1980s, there has been a steady increase in Sino-Vietnamese (ethnic Chinese from Vietnam) businesses moving into Chinatown West, Toronto. This paper explores the relationship between Sino-Vietnamese and other Chinese in this Chinatown context. Using several surveys of economic activity, we show that Chinatown is undergoing an ethnic succession as Hong Kong businesses move out and are replaced by Sino-Vietnamese businesses. Interview data show that in competitive environments like Chinatown, the Sino-Vietnamese have networks that are both facilitated and constrained by sub-ethnic differences. For the Sino-Vietnamese businesses studied, their multilingualism in English, Vietnamese, Cantonese and Mandarin aids customer and supplier relations. These business networks are diverse, linking Hong Kong suppliers, Sino-Vietnamese retailers, Mainland Chinese and Vietnamese employees and customers. Nevertheless, the competitive nature of Chinatown constrains cooperation and collective action by similar businesses. [ABSTRACT FROM AUTHOR]

This paper examines the nature of the economic costs and risks involved in brownfield versus greenfield redevelopment in the Greater Toronto Area (Ontario, Canada) from a private sector perspective, and assesses the potential effectiveness of different policies and programmes designed to attenuate associated costs and risks. Through interviews, case-studies and an analysis of hypothetical development scenarios, it has been found that the perception that brownfield redevelopment is less cost-effective and entails greater risks than greenfield development, on the part of the private sector, is true for industrial projects in the province, but not for residential ones, which were found to be feasible, given the assumptions of the present study. Furthermore, the study has found that the attractiveness of residential brownfield projects can increase considerably with minor policy changes, but that promoting industrial redevelopment will require a more vigorous approach that employs a variety of environmental policy and economic development measures. [ABSTRACT FROM AUTHOR]

In many countries such as Australia, Canada and Britain, the hours of daily retail operation are controlled through the political process. This paper tests one hypothesis for why regulation is adopted. The hypothesis is that early dosing hours are a low cost institutional response to net social costs that can arise when time is used competitively to redistribute customers spatially. Competition produces this result when stores' marginal customers value longer shopping hours more highly than the average customer. Evidence is presented on the characteristics of 45 Ontario cities that had the choice of whether or not to adopt early closing hours and logit analysis is used to test the model's predictions. The estimates of the probability of choosing early closing hours are then used to test the model's prediction on store density. In general, the evidence is consistent with the hypothesis that municipal control over shopping hours in Ontario is appropriate.
This paper focuses on whether there is evidence from retail behavior in Ontario consistent with the hypothesis that shopping hours are regulated as a way of increasing the efficiency of the shopping process. To answer this question I begin by summarizing the hypothesis of Ferris (1990). This theory views regulation as a rational response to maximizing behavior, but departs from the more usual reliance on a monopoly or redistributive motive for regulation. [ABSTRACT FROM AUTHOR]

Abstract. This paper develops a transportation network model to simulate Toronto International (Malton) Airport. The model is used to determine marginal social cost prices of using Malton's facilities throughout the day. These prices are compared to present average cost prices, and congestion fees are derived. Further simulation results are used to determine the timing and location of additional airport capacity. Contrary to the recommendations of the Ministry of Transport, it was found that the next increment should be built at Malton, rather than at the proposed Pickering site, and should be delayed until the mid-1980s rather than undertaken immediately. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Sociology is the property of Canadian Journal of Sociology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents highlights a conference, titled Capitalism, Imperialism, and the Production of Nature, in July 2005 in Toronto, Ontario. The conference mirrored the intellectual, political and social genius of James O'Connor, founder of the periodical "Capitalism, Nature, Socialism." It became a homecoming of sorts for a virtual community of scholar-activists. During the first conference plenary, the attendees were treated to a timely panel debate on capitalism. Maria Mies, a leading scholar on capitalism and patriarchy, gave the keynote address, which is an analysis of the recent contradictions of global capital as enacted through war.

Introduction Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We completed a cost-effectiveness analysis based on a decision-analytic model to assess smokers hospitalised in Ontario, Canada for AMI, UA, HF, and COPD, their risk of continuing to smoke and the effects of quitting on re-hospitalisation and mortality over a 1-year period. We calculated short-term and long-term cost-effectiveness ratios. Our primary outcome was 1-year cost per quality-adjusted life year (QALY) gained. Results From the hospital payer's perspective, delivery of the OMSC can be considered cost effective with 1-year cost per QALY gained of $C1386, and lifetime cost per QALY gained of $C68. In the first year, we calculated that provision of the OMSC to 15 326 smokers would generate 4689 quitters, and would prevent 116 rehospitalisations, 923 hospital days, and 119 deaths. Results were robust within numerous sensitivity analyses. Discussion The OMSC appears to be cost-effective from the hospital payer perspective. Important consideration is the relatively low intervention cost compared to the reduction in costs related to readmissions for illnesses associated with continued smoking. [ABSTRACT FROM AUTHOR]

The article reports on civil asset forfeiture in Ontario and British Columbia. It mentions the optimal allocation of resources for the utilization of the penalty which is influenced by incentives. An overview of its comparative analysis, social welfare and private property rights as well as the Comprehensive Crime Control Act of 1984 is also presented.

Policy-makers desire an optimal balance of financial incentives to improve productivity and encourage improved quality in primary care, while also avoiding issues of risk-selection inherent to capitation-based payment. In this paper we analyze risk-selection in capitation-based payment by using administrative data for patients ( n = 11,600,911) who were rostered (i.e., signed an enrollment form, or received a majority of care) with a primary care physician ( n = 8621) in Ontario, Canada in 2010/11. We analyze this data using a relative distribution approach and compare distributions of patient costs and morbidity across primary care payment models. Our results suggest a relationship between being in a capitation-based payment scheme and having low cost patients (and presumably healthy patients) compared to fee-for-service physicians. However, we do not have evidence that physicians in capitation-based models are reducing the care they provide to sick and high cost patients. These findings suggest there is a relationship between payment type and risk-selection, particularly for low-cost and healthy patients. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? Methods: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. Results: We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. Conclusions: This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions. [ABSTRACT FROM AUTHOR]

This paper presents the application of a mechanism that provides incentives to promote transmission network expansion in the electricity system of the Ontario province. Such mechanism combines a merchant approach with a regulatory approach. It is based on the rebalancing of a two-part tariff within the framework of a wholesale electricity market with nodal pricing. The expansion of the network is carried out through auctions of financial transmission rights for congested links. The mechanism is tested for a simplified transmission grid with ten interconnected zones, ten nodes, eleven lines and seventy eight generators in the Ontario province. The simulation is carried out for both peak and non-peak scenarios. Considering Laspeyres weights, the results show that prices converge to the marginal generation cost, the congestion rent decreases and the total social welfare increases. [ABSTRACT FROM AUTHOR]

Integrated knowledge translation approaches are one way to facilitate knowledge exchange and support the use of research in practice. This paper explores the elements of an integrated knowledge translation approach using the Systems Enhancement Evaluation Initiative (SEEI) as a case study. SEEI was a 4-year project (2005-2009) that explored the impacts of new funding in Ontario's community mental health system. Here, we describe the process, relationships, and challenges of this collaborative research initiative using a building analogy: getting the right people to do the work, designing the architectural blueprints, establishing the structure, and coordinating all facets of the project. We pay particular attention to the associated constraints and benefits when conducting a large-scale multisite evaluation. [ABSTRACT FROM AUTHOR]

In this paper we examine the changes in continuity of care (CoC) likely to be affected by new system investments and the contributing factors. A mixed method approach was used. Decision-makers participated in two rounds of qualitative interviews. A 3-year cross-sectional quantitative data collection approach was used with clients and case managers. A main finding was that new system investments can improve CoC in terms of increased care access. However, it is not clear how other CoC dimensions will be affected. New funding can also have negative consequences related to the service models in which investments are made. [ABSTRACT FROM AUTHOR]

This article examines the controversy that ensued when the Education Department of the province of Ontario, Canada, granted the tender to publish elementary school readers to the T. Eaton Company, a department store, in 1909. This decision eliminated an important source of income for retail booksellers, who could not compete with the consumer appeal of a department store, or with its option of mail-order service. Over the next decade, the booksellers fought vociferously, using a variety of strategies, in an effort to mitigate the effects of this decision on their profits. The booksellers' struggle was part of a larger campaign on the part of retailers to oppose mail-order provision of consumer goods in Canada. This historical case study contributes to our understanding of the effects of political influences and commercial pressures on the provision of textbooks, which are central to instruction in a publicly funded school system. [ABSTRACT FROM AUTHOR]

There is a growing body of research in Canada and from other countries acknowledging that immigrants face barriers in accessing health care services. As immigrants make up an increasing percentage of the population in many developed nations, a better understanding and eliminating these barriers is a major priority. This research contributes to current understandings of access among immigrant populations in Canada by exploring perceptions of access to care through focus groups with a diverse group of immigrants living in a Mississauga, Ontario neighbourhood. The results of eight focus groups reveal that immigrants face geographic, socio-cultural and economic barriers when attempting to access health care services in their community. This paper provides policy recommendations relevant to the federal, provincial and local levels for eliminating these barriers. [Copyright &y& Elsevier]

Background: Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario.Methods: We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location.Results: We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10-15 years into practice.Interpretation: We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap. [ABSTRACT FROM AUTHOR]

This study adds to the geography of complementary and alternative medicine (CAM) literature by comparing the spatial-temporal patterns of five types of CAM within 19 cities in light of clustering benefits from localization economies. CAM office location points and nearest neighbour, standard distance, local spatial autocorrelation, and Mann–Whitney analyses are utilized to test potential clustering tendencies of CAM types over time. It is shown that 'within' (chiropractors near chiropractors, for example) and 'amongst' (chiropractors proximate to other CAM types) spatial clustering occurs in 2007 and 2017. This implies the persistent influence of localization economies. Continued clustering of CAM within urban locations already replete with CAM offices will widen spatial disparities through time. This has implications for policy-makers concerned with dispersing medical resources over space for better accessibility. [ABSTRACT FROM AUTHOR]

Estimates the cost of selected economic consequences of substance abuse in Ontario. Gender differentiation of the harm of substance abuse; Hospital care; Productivity losses; Mortality and morbidity; Discount rate; Value of housekeeping.

Focuses on the use of extreme value distribution theory in economics in Ontario. Natural application of peak demand pricing; Effect of individual peak demand charge on standard industrial electricity rate; Likelihood function of individual peak demands.

Background: Most of the literature on high-cost users of health care has evaluated this population as a whole, but few studies have focused on high-cost patients with mental illness and whether they persist in the high-cost state. We sought to analyze this patient population in depth and determine predictors of persistency in the high-cost state.Methods: We used 8 years of longitudinal patient-level population data (2010-2017) from Ontario to follow high-cost patients (those in and above the 90th percentile of the cost distribution) with mental illness. We classified high-cost status, based on the proportion of the study period that patients spent in the high-cost state, as persistent (6-8 yr), sporadic (1-2 yr) or moderate (3-5 yr). We compared characteristics between groups and determined predictors of being a patient with mental illness and persistent high-cost status.Results: Among 52 638 patients with mental illness and high-cost status, 18 149 (34.5%) were considered persistent high cost. These patients had higher mean annual costs of care ($44 714, 95% confidence interval [CI] $43 724-$45 703) than patients with sporadic ($23 205, 95% CI $22 741-$23 668) and moderate ($31 055, 95% CI $30 359-31 751) status, largely owing to psychiatric hospital admissions. Patients with mental illness and persistent high-cost status were more likely to be female, older, long-term residents of Ontario (information ascertained from the Immigrants, Refugees and Citizenship Canada Database), living in low-income or urban areas, or to have comorbidities. The strongest predictors of persistent (v. sporadic) high-cost status were HIV (relative risk ratio [RRR] 4.32, 95% CI 3.08-6.06), psychosis (RRR 3.41, 95% CI 3.25-3.58) and dementia (RRR 3.21, 95% CI 2.81-3.68).Interpretation: Among patients with mental illness and high-cost status, persistence in the high-cost state was determined mainly by psychosis and other comorbidities. Quality-of-care interventions directed at managing psychosis and multimorbidity, as well as preventive interventions to target patients with mental illness before they enter the persistent high-cost state, are needed. [ABSTRACT FROM AUTHOR]

Introduction: Residents of Northern Ontario have limited access to local psychiatric care. To address this, three program models exist: (1) telepsychiatry; (2) psychiatrists traveling to underserved areas; and (3) reimbursing patients for travel to a psychiatrist. Evidence shows that telepsychiatry has comparable outcomes to in-person consultations. The objective of this study was to determine the cost difference between programs.Methods: A cost-minimization analysis estimating cost per visit from a public healthcare payer economic costing perspective was conducted. Data on fixed and variable costs were obtained. Evidence-based assumptions were made where relevant. Base-case scenarios and a break-even analysis were completed, as well as deterministic and probabilistic sensitivity analyses, to explore the effects of parameter variability on program costs.Results: Costs per visit were lowest in telepsychiatry (CAD$360) followed by traveling physicians (CAD$558) and patient reimbursement (CAD$620). Among the 100,000 Monte Carlo simulations, results showed telepsychiatry was the least costly program in 71.2% of the simulations, while the reimbursement and outreach programs were least costly in 15.1% and 13.7% of simulations, respectively. The break-even analysis found telepsychiatry was the least costly program after an annual patient visit threshold of approximately 76 visits (compared to traveling psychiatrists) and 126 visits (compared to reimbursed patients).Discussion: Our analyses support telepsychiatry as the least costly program. These results have important implications for program planning, including the prioritization of telepsychiatry, increased integration of telepsychiatry with other modalities of outreach psychiatry, and limiting use of the patient remuneration program to where medically necessary, to reduce overall cost. [ABSTRACT FROM AUTHOR]

Background: There is a lack of data in Canada on the longitudinal effects of adverse events that occur in hospital, specifically in the period after discharge. Our objective was to quantify the impact of adverse events on hospital length of stay, length of person-centred episodes of care (PCEs) and costs of PCEs, as well as their impact on the total health system.Methods: We conducted a population-based, retrospective cohort study using linked health administrative databases. We included adults in Ontario who had an acute hospital admission between Apr. 1, 2015, and Mar. 31, 2016. We grouped hospital admissions into 1 of 9 episode types and used the Canadian Institute for Health Information methodology for hospital harm to measure adverse events. We specified generalized linear models to estimate the impact of hospital harm on the following: incremental length of index acute hospital admission, incremental length of the PCE, and incremental costs of the PCE.Results: Out of 610 979 hospital admissions, 36 004 (5.9%) involved an occurrence of harm. The impact of harm on the incremental length of hospital stay ranged from 0.4 to 24.2 days (p < 0.001); the incremental length of the PCE ranged from 0.3 to 30.2 days (p < 0.001); and the incremental costs of the PCE ranged from $800 to $51 067 (p < 0.001). Total hospital days attributable to hospital harm amounted to 407 696, and the total attributable cost to the Ontario health system amounted to $1 088 330 376.Interpretation: We found that experiencing harm in hospital significantly affects both in-hospital and post-discharge use of health services and costs of care, and constitutes an enormous expense to Ontario's publicly funded health system. [ABSTRACT FROM AUTHOR]

Background: Research has shown that a small proportion of patients account for the majority of health care spending. The objective of this analysis was to determine the amount and proportion of preventable acute care spending among high-cost patients.Methods: We examined a population-based sample of all adult high-cost patients using linked administrative health care data housed at ICES in Toronto, Ontario. High-cost patients were defined as those in and above the 90th percentile of the cost distribution. Preventable acute care (emergency department visits and hospitalisations) was defined using validated algorithms. We estimated costs of preventable and non-preventable acute care for high- and non-high-cost patients by category of visit/condition. We replicated our analysis for persistent high-cost patients and high-cost patients under 65 years and those 65 years and older.Results: We found that 10% of all acute care spending among high-cost patients was considered preventable; this figure was higher for non-high-cost patients (25%). The proportion of preventable acute care spending was higher for persistent high-cost patients (14%) and those 65 years and older (12%). Among ED visits, the largest portion of preventable care spending was for primary care treatable conditions; for hospitalisations, the highest proportions of preventable care spending were for COPD, bacterial pneumonia and urinary tract infections.Conclusions: Although high-cost patients account for a substantial proportion of health care costs, there seems to be limited scope to prevent acute care spending among this patient population. Nonetheless, care coordination and improved access to primary care, and disease prevention may prevent some acute care. [ABSTRACT FROM AUTHOR]

Home care is an integral aspect of the Canadian health care system. Services provided to individuals allow them to live with independence and dignity within the comfort of their own residences. This article examines the historical evolution of Ontario's home care reform and the current challenges faced by staff members, patients, and their caregivers in reference to health equity. Political economy and feminist lenses are used to highlight the impact of market-based health care reforms on gendered experiences and access to home care services. Research and reports are used to critique the development of the home care system to date. Findings suggest that the current home care system is underfunded, understaffed, and inequitable in access to care. At this time, policies strategically remain blinded to the harsh realities of the home care sector in order to justify cost cutting, deregulation, and privatization of services. [ABSTRACT FROM AUTHOR]

Objective: While it is generally accepted that adults with intellectual and developmental disabilities (IDDs) use health services to a greater extent than the general population, there is remarkably little research that focuses on the costs associated with their health care. Using population‐based data from adults with IDD in Ontario, this study aimed to estimate overall health care costs, classify individuals into high and non‐high cost categories and describe differences in the demographics, clinical profiles and health care use patterns between these groups. Design A retrospective cohort study based in Ontario, Canada, was conducted with the use of linked administrative health data. Methods: A costing algorithm developed for the general population in Ontario was applied to estimate health care costs of adults with IDD under age 65 for 2009 and 2010. Individuals were categorised into two groups according to whether their total annual health care costs were among the highest decile in the general population. These groups were compared on demographic and clinical variables, and relative mean costs for six types of health care services in the two groups were computed. In addition, we computed the proportion of individuals who remained in the high cost group over 2 years. Results: Among adults with IDD, 36% had annual health care expenditures greater than $2610 CAD (top decile of all Ontario adults under 65). These individuals were more likely to be female, to be in the oldest age groups, to live in group homes and to be receiving disability income support than individuals whose expenditures were below the high cost threshold. In addition, they had higher rates of all the physical and mental health conditions studied. Greatest health care expenses were due to hospitalisations, especially psychiatric hospitalisations, continuing care/rehabilitation costs and medication costs. The majority of individuals whose health care costs placed them in the high cost category in 2009 remained in that category a year later. Discussion: Adults with IDD are nearly 4 times as likely to incur high annual health care costs than those without IDD. Individuals with IDD and high health care costs have unique health and demographic profiles compared with adults with IDD whose annual health care costs are below the high cost threshold. Attending to their health care needs earlier in their health care trajectory may be an opportunity to improve health and reduce overall health care costs. It is important that we explore how to best meet their needs. Models proposed to meet the needs of adults with high health care costs in the general population may not apply to this unique group. [ABSTRACT FROM AUTHOR]

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Canada has strengthened intellectual property (IP) protections for pharmaceutical drugs several times over the last 3 decades. This study investigates whether the IP changes had an effect on the market exclusivity time of brand products on the Ontario Drug Benefit (ODB) formulary. We constructed a database that included the first brand approval date for drugs launched between 1974 and 2012, the first ODB listing date of the brand drug, and the first ODB listing date of the generic form of the drug. We then calculated the time of formulary exclusivity to detect any changes in market exclusivity times associated with changes to Canada's IP regimen. There were 595 drugs launched between 1974 and 2012 that were available for analysis. Exclusivity gradually declined from the late 1970s to 1990. Drugs approved in 2004 received 7.6 years of exclusivity, and drugs approved in 2005 received 5 years of exclusivity. Over the time period we analyzed, market exclusivity time of brand drugs experienced marked changes, but we did not detect any systematic effects of Canada's stronger pharmaceutical IP laws on the market exclusivity. [ABSTRACT FROM AUTHOR]

Abstract: This qualitative study examined caregivers' experiences with SafeCare®, an evidence‐based programme that focuses on child neglect through modules on health, safety, and parenting. Shortly after completing SafeCare, 30 caregivers participated in a semi‐structured interview about their experiences with the programme. Overall, caregivers indicated that the programme helped with improvements in their parenting skills. Among the factors that contributed to a positive experience were the simplicity of language, the skills‐based approach, and the quality of the relationship with the SafeCare provider. Caregivers also noted several factors that made it difficult to fully benefit from the programme, including financial constraints, removal of their child from the home, and general distrust towards the child welfare system. Findings provide relevant information for SafeCare providers in terms of identifying areas that work well for caregivers completing the programme, as well as areas that might serve as impediments. Implications for contemporary child welfare practice are also considered. [ABSTRACT FROM AUTHOR]

The objective of our study was to estimate direct healthcare costs incurred by a population-based sample of people with psychological distress or depression. We used the 2002 Canadian Community Health Survey on Mental Health and Well Being and categorized individuals as having psychological distress using the Kessler-6, major depressive disorder (MDD) using DSM-IV criteria and a comparison group of participants without MDD or psychological distress. Costs in 2013 USD were estimated by linking individuals to health administrative databases and following them until March 31, 2013. Our sample consisted of 9,965 individuals, of whom 651 and 409 had psychological distress and MDD, respectively. Although the age-and-sex adjusted per-capita costs were similarly high among the psychologically distressed ($3,364, 95% CI: $2,791, $3,937) and those with MDD ($3,210, 95% CI: $2,413, $4,008) compared to the comparison group ($2,629, 95% CI: $2,312, $2,945), the population-wide excess costs for psychological distress ($441 million) were more than twice that for MDD ($210 million) as there was a greater number of people with psychological distress than depression. We found substantial healthcare costs associated with psychological distress and depression, suggesting that psychological distress and MDD have a high cost burden and there may be public health intervention opportunities to relieve distress. Further research examining how individuals with these conditions use the healthcare system may provide insight into the allocation of limited healthcare resources while maintaining high quality care. [ABSTRACT FROM AUTHOR]

Background: Although not always recognized as a pressing health care problem, wounds are a common, complex and costly condition. The burden of treating wounds is growing rapidly due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide. The Integrated Client Care (ICC) Project was a multi-year initiative to develop and test a new, integrated model of wound care within the home care sector in Ontario, Canada to improve health outcomes for patients and decrease system costs.Methods: Cluster randomized trial, with allocation of intervention randomized at the cluster level (14 home care centers) and analysis of outcomes based on individual-level data (patients). Primary analysis was an intention-to-treat (ITT) analysis. Two wound types, diabetic foot ulcers and pilonidal sinus, were selected as tracer conditions to assess the impact of the intervention on two different patient populations. Time to successful discharge from home care was analyzed using multivariable Cox proportional hazards regression. Hazard ratios (HRs) and 95% confidence intervals (CIs) are presented.Results: A total of 12,063 diabetic foot ulcer patients and 1954 pilonidal sinus patient records were available for analysis. No appreciable differences were observed between patients in the control and intervention arms for either of the primary or secondary analyses in either condition group. In the diabetic foot ulcer group, 72.7% patients in the control arm and 73.6% patients in the intervention arm were discharged in the follow-up period (HR 1.05; 95% CI 0.94 to 1.17). In the pilonidal sinus group, 91.0% patients in the control arm and 89.0% patients in the intervention arm were discharged in the follow-up period (HR 0.96; 95% CI 0.82 to 1.12).Conclusion: As implemented, the ICC intervention was not effective, most likely due to failure of implementation, and is, therefore, not ready for widespread implementation in Ontario. Significant work remains to be done to correct the implementation process so that the concept of outcome-based health care can be properly evaluated.Trial Registration: ClinicalTrials.gov, ID: NCT01573832 . Registered on 12 January 2012. [ABSTRACT FROM AUTHOR]

An obesity paradox has been described, whereby obese patients have better health outcomes than normal weight patients in certain clinical situations, including cardiac surgery. However, the relationship between body mass index (BMI) and resource utilization and costs in patients undergoing coronary artery bypass graft (CABG) surgery is largely unknown. We examined resource utilization and cost data for 53,224 patients undergoing CABG in Ontario, Canada over a 10-year period between 2002 and 2011. Data for costs during hospital admission and for a 1-year follow-up period were derived from the Institute for Clinical Evaluative Sciences, and analyzed according to pre-defined BMI categories using analysis of variance and multivariate models. BMI independently influenced healthcare costs. Underweight patients had the highest per patient costs ($50,124 ± $36,495), with the next highest costs incurred by morbidly obese ($43,770 ± $31,747) and normal weight patients ($42,564 ± $30,630). Obese and overweight patients had the lowest per patient costs ($40,760 ± $30,664 and $39,960 ± $25,422, respectively). Conversely, at the population level, overweight and obese patients were responsible for the highest total yearly population costs to the healthcare system ($92 million and $50 million, respectively, compared to $4.2 million for underweight patients). This is most likely due to the high proportion of CABG patients falling into the overweight and obese BMI groups. In the future, preoperative risk stratification and preparation based on BMI may assist in reducing surgical costs, and may inform health policy measures aimed at the management of weight extremes in the population. [ABSTRACT FROM AUTHOR]

Background:In 1998, the province of Ontario, Canada implemented price-cap ‘70/90ʹ regulations: the first generic must be priced at ≤70% of the associated brand-name price and subsequent generics must be priced at ≤90% of the first generics’ price. The price-cap was further lowered to 50% in 2006 and 25% in 2010 for all generic drugs regardless of the first or subsequent generic entrants. This study assessed the impact of such price-cap regulations on market entry by generic firms using the formulary database from 9 provinces (January 2004-March 2013). Methods:A logistic regression was estimated to compare the probability of entry during the three policy periods in Ontario (‘70/90ʹ, ‘25ʹ, versus ‘50ʹ). Since different price-caps were subsequently introduced in other provinces, Alberta, British Columbia, New Brunswick and Saskatchewan, difference-in-differences was used to compare market entry. Results:In Ontario, compared with the period ‘50ʹ, generic firms were 76% and 63% less likely to enter markets in the periods ‘25ʹ and ‘70/90ʹ, respectively. The difference-in-differences showed that the entry probability decreased the most in Ontario during the ‘25ʹ period from the ‘50ʹ period. Conclusion:Lowering the price-cap level to 25% leads to a significantly lower probability of market entry by generic firms. [ABSTRACT FROM PUBLISHER]

Background: The ColonCancerCheck screening program for colorectal cancer (CRC) in Ontario, Canada, is considering switching from biennial guaiac fecal occult blood test (gFOBT) screening between age 50–74 years to the more sensitive, but also less specific fecal immunochemical test (FIT). The aim of this study is to estimate whether the additional benefits of FIT screening compared to gFOBT outweigh the additional costs and harms. Methods: We used microsimulation modeling to estimate quality adjusted life years (QALYs) gained and costs of gFOBT and FIT, compared to no screening, in a cohort of screening participants. We compared strategies with various age ranges, screening intervals, and cut-off levels for FIT. Cost-efficient strategies were determined for various levels of available colonoscopy capacity. Results: Compared to no screening, biennial gFOBT screening between age 50–74 years provided 20 QALYs at a cost of CAN$200,900 per 1,000 participants, and required 17 colonoscopies per 1,000 participants per year. FIT screening was more effective and less costly. For the same level of colonoscopy requirement, biennial FIT (with a high cut-off level of 200 ng Hb/ml) between age 50–74 years provided 11 extra QALYs gained while saving CAN$333,300 per 1000 participants, compared to gFOBT. Without restrictions in colonoscopy capacity, FIT (with a low cut-off level of 50 ng Hb/ml) every year between age 45–80 years was the most cost-effective strategy providing 27 extra QALYs gained per 1000 participants, while saving CAN$448,300. Interpretation: Compared to gFOBT screening, switching to FIT at a high cut-off level could increase the health benefits of a CRC screening program without considerably increasing colonoscopy demand. [ABSTRACT FROM AUTHOR]

Background: Seniors living in subsidized housing have lower income, poorer health, and increased risk for cardiometabolic diseases and falls. Seniors also account for more than one third of calls to Emergency Medical Services (EMS). This study examines the effectiveness of the Community Health Assessment Program through EMS (CHAP-EMS) in reducing blood pressure, diabetes risk, and EMS calls.Methods: Paramedics on modified duty (e.g. injured) conducted weekly, one-on-one drop-in sessions in a common area of one subsidized senior's apartment building in Hamilton, Ontario. Paramedics assessed cardiovascular, diabetes, and fall risk, provided health education, referred participants to local resources, and encouraged participants to return to CHAP-EMS for follow-up. Reports were faxed to the family physician regularly. Blood pressure was collected throughout the one year intervention, while diabetes risk was assessed at baseline and after 6-12 months. EMS call volumes were collected from the Hamilton Paramedic Service for two years pre-intervention and one year during the intervention.Results: There were 79 participants (mean age = 72.2 years) and 1,365 participant visits to CHAP-EMS. The majority were female (68%), high school educated or less (53%), had a family doctor (90%), history of hypertension (58%), high waist circumference (64%), high body mass index (61%), and high stress (53%). Many had low physical activity (42%), high fat intake (33%), low fruit/vegetable intake (30%), and were current smokers (29%). At baseline, 42% of participants had elevated blood pressure. Systolic blood pressure decreased significantly by the participant's 3rd visit to CHAP-EMS and diastolic by the 5th visit (p < .05). At baseline, 19% of participants had diabetes; 67% of those undiagnosed had a moderate or high risk based on the Canadian Diabetes Risk (CANRISK) assessment. 15% of participants dropped one CANRISK category (e.g. high to moderate) during the intervention. EMS call volume decreased 25% during the intervention compared to the previous two years.Conclusions: CHAP-EMS was associated with a reduction in emergency calls and participant blood pressure and a tendency towards lowered diabetes risk after one year of implementation within a low income subsidized housing building with a history of high EMS calls.Trial Registration: Retrospectively registered on May 12th 2016 with clinicaltrials.gov: NCT02772263. [ABSTRACT FROM AUTHOR]

Background: The National Lung Screening Trial (NLST) results indicate that computed tomography (CT) lung cancer screening for current and former smokers with three annual screens can be cost-effective in a trial setting. However, the cost-effectiveness in a population-based setting with >3 screening rounds is uncertain. Therefore, the objective of this study was to estimate the cost-effectiveness of lung cancer screening in a population-based setting in Ontario, Canada, and evaluate the effects of screening eligibility criteria.Methods and Findings: This study used microsimulation modeling informed by various data sources, including the Ontario Health Insurance Plan (OHIP), Ontario Cancer Registry, smoking behavior surveys, and the NLST. Persons, born between 1940 and 1969, were examined from a third-party health care payer perspective across a lifetime horizon. Starting in 2015, 576 CT screening scenarios were examined, varying by age to start and end screening, smoking eligibility criteria, and screening interval. Among the examined outcome measures were lung cancer deaths averted, life-years gained, percentage ever screened, costs (in 2015 Canadian dollars), and overdiagnosis. The results of the base-case analysis indicated that annual screening was more cost-effective than biennial screening. Scenarios with eligibility criteria that required as few as 20 pack-years were dominated by scenarios that required higher numbers of accumulated pack-years. In general, scenarios that applied stringent smoking eligibility criteria (i.e., requiring higher levels of accumulated smoking exposure) were more cost-effective than scenarios with less stringent smoking eligibility criteria, with modest differences in life-years gained. Annual screening between ages 55-75 for persons who smoked ≥40 pack-years and who currently smoke or quit ≤10 y ago yielded an incremental cost-effectiveness ratio of $41,136 Canadian dollars ($33,825 in May 1, 2015, United States dollars) per life-year gained (compared to annual screening between ages 60-75 for persons who smoked ≥40 pack-years and who currently smoke or quit ≤10 y ago), which was considered optimal at a cost-effectiveness threshold of $50,000 Canadian dollars ($41,114 May 1, 2015, US dollars). If 50% lower or higher attributable costs were assumed, the incremental cost-effectiveness ratio of this scenario was estimated to be $38,240 ($31,444 May 1, 2015, US dollars) or $48,525 ($39,901 May 1, 2015, US dollars), respectively. If 50% lower or higher costs for CT examinations were assumed, the incremental cost-effectiveness ratio of this scenario was estimated to be $28,630 ($23,542 May 1, 2015, US dollars) or $73,507 ($60,443 May 1, 2015, US dollars), respectively. This scenario would screen 9.56% (499,261 individuals) of the total population (ever- and never-smokers) at least once, which would require 4,788,523 CT examinations, and reduce lung cancer mortality in the total population by 9.05% (preventing 13,108 lung cancer deaths), while 12.53% of screen-detected cancers would be overdiagnosed (4,282 overdiagnosed cases). Sensitivity analyses indicated that the overall results were most sensitive to variations in CT examination costs. Quality of life was not incorporated in the analyses, and assumptions for follow-up procedures were based on data from the NLST, which may not be generalizable to a population-based setting.Conclusions: Lung cancer screening with stringent smoking eligibility criteria can be cost-effective in a population-based setting. [ABSTRACT FROM AUTHOR]

The article provides information on the consumption and production of greenhouse gas emission for Ontario and its associate trade flows, during the production process of final good and services. Topics discussed includes Investment in greenhouse gas emission, Trade flow from Ontario to Quebec and motor gasoline to Ontario.