Three essays on health economics for populations with vulnerability in Canada

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Han, Jing
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This thesis consists of three essays that use empirical analyses in health economics to address various issues related to health status, social and economic determinants of health and utilization of health care resources for populations with vulnerability, in particular immigrants and homeless people in Canada. The first essay explores the influence of one of the most important social and economic factors - labor force status - on the health outcomes of Canada’s immigrants. This paper provides cross-sectional analyses on the marginal responses of self-assessed general and mental health status to an unemployment shock faced by eligible labor force participants drawn from the Canadian Community Health Survey (CCHS) 2010. The results show robust evidence that Canada’s immigrant population is much more vulnerable to an unemployment shock compared to their native-born counterparts. Given the detrimental impact of unemployment on the health of immigrants, the need for social policies and strategies that effectively reduce unemployment and create favorable vocational opportunities are necessary to substantially improve immigrants’ health and to reduce the effect of these avoidable health expenditures on the Canadian healthcare budget. The second essay investigates the roles of various social supports in easing the psychological distress of unemployed immigrants over a ten-year time period by employing longitudinal data drawn from cycles 4 to 9 of the National Population Health Survey (NPHS). Fixed effects and random effects logit models and survival analyses are used in the estimations. The results suggest that social supports play a fundamental role in reducing psychological distress from unemployment for immigrants compared to matched non-immigrants. The survival trajectories demonstrate that social supports have positive influences on mental health, which significantly ease mental distress from unemployment, especially for the Canadian immigrant population. The third essay is a systematic study to investigate and identify emergency department (ED) use among homeless people in Canada; in particular, this paper aims to understand and map the main reasons for emergency department (ED) visits and the contributing factors to various ED visit dispositions (especially in-patient admission to hospitalization) following episodes of ED visits. Record-level claim data from the National Ambulatory Care Reporting System (NACRS) during four budgetary years (2009-2010 to 2013-2014) are used for the estimations. The results of the analyses suggest that the main reasons for ED visits by homeless adults in Canada are mental and behavioral disorders, as well as external hazard-related issues, which also predict significantly higher cost of ED visits compared to other general medical causes. However, they are not identified as major causes of medically necessary in-patient hospitalizations for homeless adults in Canada in the multinomial logistic analyses.
Canada’s Immigrant health, Unemployment, Social Supports, Psychological distress, Homelessness, Emergency Department, Health Economics