Vol.
25, No. 1 March/mars 1999
Articles:
National
Pharmacare, Reference-Based Pricing, and Drug R&D: A Critique
of the National Forum on Health's Recommendations for Pharmaceutical
Policy
Robin Lindsey and Douglas S. West
In
February 1997, the Canadian National Forum on Health presented its
recommendations for a pharmaceutical policy for Canada.
These
recommendations include moving towards a universal coverage, publicly
funded drug plan; support for reference-based pricing as a method
of containing drug plan costs; and requiring that pharmaceutical companies
turn over a portion of their research funds to the national research
granting agencies. This paper provides a critical assessment of these
policy recommendations, with a focus on whether they are likely to
achieve long-term reductions in pharmaceutical and health care expenditures
in Canada.
Patent
Protection and Pharmaceutical R&D Spending in Canada
Bohumir Pazderka
After almost two decades of compulsory licensing of prescription drugs,
Canada restored full patent protection in two legislative steps taken
in 1987 and 1992. The paper investigates the impact of the strengthening
of intellectual property rights on corporate R&D spending in the
Canadian pharmaceutical industry. Interindustry comparisons of R&D
spending trends within Canada, intercountry comparisons of R&D
spending trends within the pharmaceutical industry, as well as trends
in Canada's share of foreign R&D spending of US-owned multinationals
suggest a statistically significant increase in Canadian pharmaceutical
R&D spending after 1987.
Standardized
Mortality Ratios and Canadian Health-Care Funding
Kelly Bedard, John Dorland, Allan W. Gregory and Mark Rosenberg
Needs-based
capitation models have been suggested as an alternative to health-care
funding methods based on historical utilization patterns. The standardized
mortality ratio (SMR) applied in conjunction with an age/gender adjustment
is the most widely adopted measure of relative need. This paper addresses
a number of important index construction issues using Canadian data
and discusses their health policy implications. These include the
influence exerted by the age structure (excluding people over 64 versus
74), the optimal period over which to average the SMR in order to
smooth meaningless fluctuations, and the correspondence between SMRs,
standard socioeconomic indicators (i.e., unemployment, education,
and income) health-care "need," and expenditures.
Wage
Discrimination Against Natives
Arnold de Silva
This paper examines wage discrimination facing native paid employees
working both full-time and part-time, living on and off reserves,
using the 1991 census data. It finds that the native-white wage differential
is mainly attributable to endowment differences, which implies that
potential discrimination is relatively minor. It also finds that,
contrary to a priori expectations, native workers of exclusively aboriginal
origin do not always experience less potential discrimination than
native workers of mixed ethnicity.
On
the Concept and Dimension of Human Capital in a Knowledge-Based
Mireille Laroche, Marcel Mérette and G.C. Ruggeri
Economy Context Technological changes, along with the globalization
of markets, are transforming industrial countries into knowledge-driven
economies. This shift has made human capital one of the leading public
policy themes. However, existing measures of investment do not allow
policymakers to comprehend fully the implications of human capital
on economic performance and technological advancement. This paper
discusses the elements of a comprehensive definition of human capital
and identifies the fundamental differences between human and physical
capital. It shows that the main features of human capital and its
differences with physical capital have implications for national income
acounting, the classification of government expenditures, and the
endogenous growth literature.
Is
It Worth Doing a Science or Technology Degree in Canada? Empirical
Evidence and Policy Implications
Marie Lavoie and Ross Finnie
This
paper looks at the early careers of science and technology graduates
in Canada using three waves of the National Graduates Surveys. Employment
rates, earnings levels, job satisfaction, the job-education skill
match, and the overall evaluation of the education program are studied
in order to evaluate the attractiveness of careers in science and
technology and the degree to which these graduates' skills and talents
are being efficiently utilized. We find that computer science and
health graduates have generally done very well; that engineers have
performed in a solid, although not spectacular, fashion; and that
pure and especially applied science graduates have lagged behind,
especially at the undergraduate level. The implications of these findings
for the accumulation of the science and technology knowledge bases
in Canada in the context of the emerging "knowledge-based economy"
are discussed.
ISSUES
AND COMMENTARIES
Health
Care in Regression: Contradictions, Tensions and Implications for
Canadian Seniors
Susan A. McDaniel and Neena L. Chappell
Aging
and seniors pose perplexing dilemmas to neoliberal agendas of health
care "reform" and the concept of cost-cutting efficiency.
At the same time, seniors are affected directly, and often first,
by shifting health care priorities and processes, and they influence
health care change. Contradictions, tensions and implications of current
trends in Canadian health care are explored along five dimensions:
the valuing of public health care by Canadians, attitudes toward cost-reductions,
good health and longevity as intergenerational legacies, the vision
of health care reform versus the reality, and health as a private/public
good. Contradictions abound as well as a significant gap between current
health care reform tendencies and public opinion.
Restructuring
the University System: What Level of Public Support?
H. Lorne Carmichael
It seems inevitable that universities in Canada will be increasing
their reliance on tuition as a source of income. This paper works
out an optimal tuition subsidy formula for a full tuition university
system where investments in higher-education are treated by the tax
system in the same way as investments in physical capital. The optimal
subsidy is quite substantial in some cases. In general, with enlightened
tax policy, there is no reason to fear that a full tuition regime
will reduce the quality, equity, or accessibility of the university
system.
