Private Health Insurance and Health Inequalities in a National Health System

Amélie Quesnel-Vallée, McGill University
Emilie Renahy, St Michael's Hospital

Despite a legal guarantee of universal public coverage in Canada for all medically necessary services, gaps exist in the public insurance of specific services, and supplementary private insurance (SPHI) has developed to bridge them. Using data from the Canadian National Population Health Survey 1994/95-2004/05, we assess the contribution of SPHI to social inequalities in unmet health needs because of cost. Path analyses were estimated using Mplus® v4.0. SPHI coverage among 35-44 yo appeared to mitigate health inequalities and to have a positive impact only when barriers to health care utilization occur. In contrast, among 45-54 yo, SPHI tended to exacerbate health inequalities and shows a positive impact on later health status both directly and indirectly through unmet needs. Our results suggest that the breadth of coverage in a national health system can contribute to health inequalities and highlight the importance of these trends in a cost-shifting context.