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Rose Gagnon,1,2 Kadija Perreault,1,2 Jason R Guertin,3,4 Simon Berthelot,4– 6 Bertrand Achou,7 Luc J Hébert1,2,8 1Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre intégré universitaire de santé et de services sociaux (CIUSSS) de La Capitale-Nationale, Quebec City, Quebec, Canada; 2Department of Rehabilitation, Université Laval, Quebec City, Quebec, Canada; 3Department of Social and Preventive Medicine, Université Laval, Quebec City, Quebec, Canada; 4Centre de recherche du CHU de Québec – Université Laval, Quebec City, Quebec, Canada; 5Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada; 6CHU de Québec – Université Laval, Quebec City, Quebec, Canada; 7HEC Montreal, Montreal, Quebec, Canada; 8Department of Radiology and Nuclear Medicine, Université Laval, Quebec City, Quebec, CanadaCorrespondence: Luc J Hébert, Cirris, CIUSSS de la Capitale-Nationale, 525 Boulevard Wilfrid-Hamel, H-1410, Quebec City, Quebec, G1M 2S8, Canada, Tel +1 418 529-9141 ext 6579, Email lucj.hebert@fmed.ulaval.caBackground: Musculoskeletal disorders (MSKDs) are among the most disabling and costly non-fatal health conditions. They may lead to long-term consequences such as chronic pain, physical limitations, and poorer quality of life. They also account for a significant proportion of emergency department visits, representing between 18% and 25% of all visits, depending on country.Purpose: To assess the health-related quality of life of patients presenting to the emergency department with a MSKD, to convert their answers to utility scores and to explore the association between diverse socio-demographic and clinical variables and patients’ health-related quality of life.Patients and Methods: This is an analysis of cross-sectional data obtained during the baseline assessment performed as part of a 6-month pragmatic randomized controlled trial conducted in an academic emergency department. We included patients aged 18– 80 years with a minor MSKD. The main outcome measures were health-related quality of life (five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and utility scores (− 0.148 – worse than death, 0 – dead, 0.949 – perfect health) measured with the EQ-5D-5L. Possible associations were explored by comparing scores across subgroups based on certain socio-demographic (eg, age, gender, triage score) and clinical factors (eg, pain interference on function, pain intensity) and with reference values using descriptive statistics (mean, median), rankFD ANOVAs, and χ2 tests.Results: Sixty-nine participants completed the EQ-5D-5L. Mean and median utility scores were, respectively, 0.536 (95% CI: 0.479– 0.594) and 0.531 (IQR: 0.356– 0.760). Participants with higher levels of pain (< 4/10: 0.741, 95% CI: 0.501– 0.980; 4– 7/10: 0.572, 0.500– 0.644; > 7/10: 0.433, 0.347– 0.518) or pain interference on function (< 4/10: 0.685, 95% CI: 0.605– 0.764; 4– 7/10: 0.463, 0.394– 0.533; > 7/10: 0.294, 0.126– 0.463) presented significantly lower utility scores. No significant differences were found for other socio-demographic characteristics.Conclusion: In patients with MSKDs who present to the emergency department, higher levels of pain or pain interference are associated with decreased health-related quality of life. These findings need to be confirmed on a larger scale.Keywords: EQ-5D-5L, quality of life, pain, emergency services, musculoskeletal disorders

Housing is mostly exempted from Medicaid and Supplemental Social Insurance means tests. Reforms of this special treatment have been debated, but little is known about its costs, benefits, and redistributive implications. I estimate a life cycle model of single retirees accounting for this exemption. It shows that the homestead exemption explains important patterns of Medicaid recipiency and that it is highly valued. It also shows that estate recovery could cover most of its costs with possibly limited negative welfare consequences. Finally, the model predicts that removing the homestead exemption or enforcing estate recovery programs would reduce redistribution toward lower-income retirees. (JEL D15, G51, H51, I13, I18, I38, J26)

In this article, the authors address concerns about the impact that the aging of Canada's population over the coming decades could have on economic growth and, consequently, growth in government revenues. They explore how revenue-neutral changes in the tax mix today could mitigate those concerns and raise more revenue than is projected in current forecasts with a status-quo scenario. Using data for Quebec, the authors show that a shift in the relative share of total revenues from personal income taxes to consumption taxes could be quite effective over the next four decades. A revenue-neutral shift equivalent to 1 percent of the province's consumption tax revenues today would result in an increase in revenues ranging between 0.3 percent and 1.0 percent by 2060, while a shift equivalent to 25 percent of consumption tax revenues would generate additional revenues of 1.4 percent to 4.8 percent.