Published Papers

Financial Dependence and Growth: Diminishing Returns to Improvement in Financial Development,” Economics Letters, forthcoming.

The Effect of Social Capital on the Use of General Practitioners: A comparison of Immigrants and Non-Immigrants in Ontario,” with D. A. Samek, A. Laporte, E. Nauenberg, and P. C. Coyte,Healthcare Policy, 2012.

Social Capital, Community Size and Utilization of Health Services: A Lagged Analysis,” with A. Laporte and E. Nauenberg, Health Policy, 2011.

Aging, Social Capital, and Utilization of Health Services in Canada,” with A. Laporte and E. Nauenberg, Health Economics, Policy and Law, 2009.

 

Financial Dependence and Growth: Diminishing Returns to Improvement in Financial Development

This paper examines how much financial development facilitates economic growth by nonparametrically estimating the effect of financial development on reducing the costs of external finance to firms. The data reveal substantial evidence of diminishing returns to improvement in financial development.

 

The Effect of Social Capital on the Use of General Practitioners: A Comparison of Immigrants and Non-Immigrants in Ontario

Social capital, a resource arising from the social interaction among individuals, may be a determinant of medical care use. This study explored the interaction between community- and individual-level social capital and immigrant status on the propensity and frequency of physician visits. The results showed that community social capital, as measured by the Petris Social Capital Index, was not significant in any of the analyses. However, a sense of belonging to the local community tended to decrease the number of doctor visits made by immigrants, while tangible social support increased and affection decreased the frequency of GP consultations by non-immigrants. Further research is required to determine which types of social capital affect utilization of different health services. These findings also highlight the importance of being aware of potential interactions between the formal and informal components of the healthcare system.

 

Aging, Social Capital and Utilization of Health Services: A Lagged Analysis

This paper examines relationships between aging, social capital, and healthcare utilization. Survey data from the 2002 Canadian Community Health Survey (wave 1.2) and the 2001 Canadian Census are merged with GP visit data from the Ontario Ministry of Health and Long Term Care for FY 2006 to estimate a negative binomial regression model focusing on the impact of community- (CSC) and individual-level social capital (ISC). CSC is measured using the Petris Social Capital Index (PSCI) based on employment levels in religious and community-based organizations [NAICS 813XX] and three different measures used for ISC. The regression results indicate differential results based on whether a person lives in a census metropolitan area (>100,000) or a smaller community (population 10,000 – 100,000). A one standard deviation increase (0.08%) in the PSCI index in these larger communities leads to a 2.6% decrease in GP visits and an annual offset in Ontario of approximately $62.3 M. In smaller communities, CSC exhibited no significant impact upon utilization, but higher levels of ISC were associated with fewer annual GP visits. Each form of social capital likely operates through a different mechanism and differentially by community size. Stronger CSC likely obviates some physician visits in larger communities that may involve counseling/caring services while some forms of ISC may act similarly in smaller communities. Policy implications of these results are discussed herein.

 

Aging, Social Capital, and Health Care Utilization in Canada

This paper examines relationships between aging, social capital, and healthcare utilization. Cross-sectional data from the 2001 Canadian Community Health Survey and the Canadian Census are used to estimate a two-part model for both GP physicians (visits) and hospitalization (annual nights) focusing on the impact of community- (CSC) and individual-level social capital (ISC). Quantile regressions were also performed for GP visits. CSC is measured using the Petris Social Capital Index (PSCI) based on employment levels in religious and community-based organizations [NAICS 813XX] and ISC is based on selfreported connectedness to community. A higher CSC/lower ISC is associated with a lower propensity for GP visits/higher propensity for hospital utilization among seniors. The part-two (intensity model) results indicated that a one standard deviation increase (0.13%) in the PSCI index leads to an overall 5% decrease in GP visits and an annual offset in Canada of approximately $225 M. The ISC impact was smaller; however, neither measure was significant in the hospital intensity models. ISC mainly impacted the lower quantiles in which there was a positive association with GP utilization, while the impact of CSC was strongest in the middle quantiles. Each form of social capital likely operates through a different mechanism: ISC perhaps serves an enabling role by improving access (e.g. transportation services), while CSC serves to obviate some physician visits that may involve counseling/caring services most important to seniors. Policy implications of these results are discussed herein.