Amélie Quesnel-Vallée (McGill) March 7: “Public-private balance of health care financing & provision: Assessing policy reforms and their impact on social inequalities in health”

Tues March 7, 11:00-12:30 (ANSO 134)

Abstract: In past decades, growth in health spending exceeded that of the gross domestic product, leading governments (including Canada) to search for alternative financing structures, notably through increases in the share of private expenditures. Yet, we still know relatively little about the processes that led to these policy reforms, or about their impact on social inequalities in access to care and health.

In this presentation, I will discuss the development of a research platform setting the stage for international and inter-provincial comparisons of private financing and provision of health care, namely the Health Insurance Access Database (HIAD).

The HIAD is a repository of harmonized policy indicators monitoring the interplay of public insurance coverage and private health expenditure and regulation. These policy indicators are coding for coverage and regulation along three analytic dimensions: by health services most likely to feature private funding or provisions (e.g. mental health, long-term care); across jurisdictions (for 9 OECD countries and the 10 Canadian provinces); and across time (1990-2010).

I will discuss how the HIAD feeds two strands of related research. First, it allows the estimation of health system arrangements and other social policies on inequalities in access to care and health, through linkages with cross-nationally harmonized, micro-level data. Second, it is used to monitor and analyse health systems policy reforms in the regulation of public and private insurance, and to conduct policy analyses of those reforms. I will provide a concrete example of this research with an analysis of the policy reforms having led to the availability of private diagnostic care in select Canadian provinces.

I will end by commenting on potential of this knowledge base for informing current debates in Canada regarding the public-private balance of health care financing and provision.


Amélie Quesnel-Vallée is Canada Research Chair in Policies and Health Inequalities, the President, RC15 Sociology of Health, International Sociological Association, the Director, International Research Infrastructure on Social inequalities in health (IRIS), and an Associate Professor at McGill University.