Grant: Travel Awards - Institute Community Support

In Canada and elsewhere, the struggle to fund escalating public health costs has put pressure on governments to find alternatives to the current, predominantly public, financing structures. One such alternative has been to turn to private funding of health care through out-of-pocket spending by individuals and the development of private health insurance markets. In Canada, for instance, private spending increased from 25.2% to 30.1% of total health expenditures from 1988 to 2004 and the proportion of total health expenditures accounted for by private health insurance spending nearly doubled (from 7.4 to 13%). Compared to public insurance, both out-of-pocket spending and private health insurance may contribute to socioeconomic differentials in health, as they may create barriers to health insurance coverage and health care access. To date, there has been limited international comparative evidence on the association between health systems characteristics and social inequalities in access to care and health status. This paper aims to address this knowledge gap by assessing the impact of health insurance coverage arrangements and regulations on social inequalities in health among developed countries with universal health coverage. Specifically, the objectives are: 1) to assess inequalities in access to health care and health status associated with household income across Canada, Germany, France, United Kingdom and Australia between 2001 and 2013; and 2) to determine the effect of barriers to health insurance coverage on income inequalities in health care access and health status, both within and across these countries. This research will feed contemporary debates on provincial, federal and international approaches to health insurance and their consequences for health outcomes across all social and economic groups. Additionally, it will provide evidence for health policy development.