Working Papers

"The Technology- Healthcare Expenditure Nexus: An Investigation of OECD Member Countries and Canadian Provinces"

(joint with Janelle Mann)


Abstract: Technology is perceived as a key factor driving the increase in per capita healthcare expenditure. But the literature reports mixed evidence, stemming from differing proxies for medical technology within healthcare, and differences in empirical methods. This paper assesses the effect of medical technology on healthcare expenditure between 1981 and 2016 for two panels that differ in level of aggregation (OECD countries and Canadian provinces), and introduces three new proxies for medical technology. The first proxy is a global proxy representing 204 countries, and the other two are country-level proxies from Canada. Results from a panel error correction model (ECM) estimated using a dynamic common correlated effect approach as proposed by Chudik and Pesaran (2015) reveal that medical technology and healthcare expenditure follow a long-run relationship. However, the speed at which the system returns to its long-run relationship depends on the choice of technology proxy and level of aggregation.


"Healthcare Utilization and the Telehealth Program in Manitoba: An Evaluation using Linked Administrative Data"


Abstract: The provision of healthcare services through telemedicine is a potential alternative to in-person interactions between patients and physicians. But evidence is limited regarding patients’ responses to this model of care. This paper empirically assesses effects of the telehealth program in Manitoba (Canada) on healthcare utilization outcomes. The treatment effect is estimated by combining inverse probability of treatment weights (after conducting a high-dimensional propensity score method) with regression models. Administrative data from the Manitoba Centre for Health Policy is linked in this paper to records from the Manitoba Telehealth Program to conduct a population-level study. Results indicate that, compared to non-users, telemedicine patients have more ambulatory visits, visits to primary care physicians and visits to specialists, as well as more hospitalizations. For two specific chronic conditions, diabetes and hypertension, the magnitude of these effects varies with patient diagnosis. Additionally, for those patients who show a higher intensity of telemedicine use, telemedicine seems to be substituting for regular care, rather than adding to it.


"The Impact of EMRs Facilitated Primary Care on Health Outcomes"


Abstract: Electronic medical records (EMR) have been widely implemented in Canada with promising prospects of improving quality of care through supporting decision-making processes and increasing efficiency. This paper estimates the effect of EMR adoption on quality of care measures at a primary care level. A set of indicators covering preventive care, chronic disease management, and healthcare utilization are studied for a panel of patients with continuous enrollment between 2009 and 2017. Using population-based data for the Canadian province of Manitoba, a difference in difference approach with patient and time fixed effects is implemented, exploiting the variation in timing of adoption. No evidence of changes in preventive care are observed, but patients with diabetes in practices using EMR’s show improved management indicators. Mixed results are found relating to utilization of healthcare services. These findings are robust across specifications.


Other Publications

Rodriguez Llorian, E. and Loxley, J. (2019). A Framework for Assessing Social Impact of The Jubilee Fund: The Case of Daycare Programs. Report prepared for the Jubilee Fund. 

Loxley, J. and Rodriguez Llorian, E. (2019). The Impact of the Mary River Project on GDP Forecasts for Nunavut: A Critical View. Report prepared for Oceans North.

Rodriguez Llorian, E. and Doimeadios Reyes, Y. (2015). Un análisis comparado de eficiencia y eficacia en el sector público en Cuba. Economía y Desarrollo, 155(2), 44-59.

Rodriguez Llorian, E., Álvarez Mendez, O., and Cribeiro Diaz, Y. (2015, April). Impacto del diferencial de precios de importación sobre la balanza comercial de Cuba: el caso de los alimentos. Revista Mercado, 8-14.  Retrieved from

Conference Proceedings

Rodriguez Llorian, E. and Mann, J. (2017). The Relationship between Healthcare Expenditure and Income in Latin American and Caribbean Countries: A Panel Time Series Approach. Canadian Stata Users' Group Meetings 2017 03, Stata Users Group. Available at


Updated October 2019 by Elisabet Rodriguez Llorian

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