Open Access Open Badges Correspondence

Assessing barriers to health insurance and threats to equity in comparative perspective: The Health Insurance Access Database

Amélie Quesnel-Vallée123*, Emilie Renahy34, Tania Jenkins35 and Helen Cerigo3

Author Affiliations

1 Department of Epidemiology, Biostatistics, and Occupational Health, Purvis Hall, McGill University, 1020 Pine Avenue West, Montreal, QC H3A 1A2, Canada

2 Department of Sociology, McGill University, Leacock Building Room 713, 855 Sherbrooke Street West, Montréal, QC H3A 2T7, Canada

3 International Research Infrastructure on Social inequalities in health, Peterson Hall Room 328,3460 McTavish Street, Montreal, QC H3A 1X9, Canada

4 Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada

5 Department of Sociology, Brown University, Box 1916 Maxcy Hall, 112 George Street, Providence, RI 02912, USA

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BMC Health Services Research 2012, 12:107  doi:10.1186/1472-6963-12-107

Published: 2 May 2012



Typologies traditionally used for international comparisons of health systems often conflate many system characteristics. To capture policy changes over time and by service in health systems regulation of public and private insurance, we propose a database containing explicit, standardized indicators of policy instruments.


The Health Insurance Access Database (HIAD) will collect policy information for ten OECD countries, over a range of eight health services, from 1990–2010. Policy indicators were selected through a comprehensive literature review which identified policy instruments most likely to constitute barriers to health insurance, thus potentially posing a threat to equity. As data collection is still underway, we present here the theoretical bases and methodology adopted, with a focus on the rationale underpinning the study instruments.


These harmonized data will allow the capture of policy changes in health systems regulation of public and private insurance over time and by service. The standardization process will permit international comparisons of systems’ performance with regards to health insurance access and equity.


This research will inform and feed the current debate on the future of health care in developed countries and on the role of the private sector in these changes.