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2301 Avenue d’Estimauville Québec (Québec) G1E 0N5 Canada
Professeure adjointe au département d’économique de l’Université Laval
Titulaire de la chaire de recherche Sentinelle Nord en économie et santé du cerveau
Axe de recherche:
Neurosciences cliniques et cognitives
Explorer les dynamiques liant la santé du cerveau, l’accumulation du capital humain et les inégalités de richesse et de revenu :
Au cours des dernières années, les problèmes de santé mentale et du cerveau se sont imposés comme un moteur de croissance de dépenses en santé à l’échelle mondiale. En parallèle, la croissance des inégalités est devenue l’un des plus épineux problèmes auxquels font face les économies. Si ces deux phénomènes représentent indépendamment des préoccupations substantielles pour les décideurs publics, leurs interactions présentent également des défis qui ne peuvent être ignorés. Les travaux de Maripier Isabelle allient les outils de la science économique, les avancées de la recherche clinique en psychiatrie et l’expertise développée dans le réseau de la santé afin d’étudier les liens de causalité entre l’évolution des distributions de revenus, les trajectoires de santé du cerveau et l’accumulation de capital humain. Certains de ses projets contribuent au développement d’approches combinant des informations cliniques et socioéconomiques afin de mieux comprendre l’influence de l’environnement et du statut socioéconomique des individus à risque de développer des maladies psychiatriques majeures sur leurs trajectoires de soins. Elle travaille également à isoler l’impact de changements au revenu relatif et au revenu absolu des individus sur leur santé physique et mentale, leur consommation de soins santé et leur mobilité socioéconomique.
Les travaux de Maripier Isabelle étudient également l’impact de la croissance des inégalités de richesse et de revenus sur l’organisation des systèmes de santé, notamment en ce qui a trait aux modifications de l’offre et de la demande pour des soins financés par les secteurs public et privé.
Finalement, ses recherches contribuent également à une meilleure compréhension de l’impact qu’ont différentes incitations financières et signaux de prix sur le comportement des médecins, sur leur offre de travail, et sur la nature et le volume des soins offerts aux patients. En utilisant des données administratives, elle a notamment étudié comment de tels facteurs influencent l’allocation des ressources au sein des systèmes de santé, et les trajectoires de soin des patients.
La recherche de Maripier Isabelle se situe à l’intersection des domaines de l’économie de la santé, de l’étude des inégalités sociales et économiques, des politiques économiques et de l’économie du travail. Elle s’intéresse à des questions ayant un impact direct sur la santé des individus, l’organisation des systèmes de santé et les pressions auxquelles ils sont soumis. Elle utilise notamment des banques de données administratives et des techniques d’analyse en microéconomie appliquée et en économétrie afin de produire des résultats susceptibles d’outiller les décideurs publics, notamment en documentant l’hétérogénéité qui caractérise ces résultats.
Maripier Isabelle est professeure adjointe au département d’économique de l’Université Laval et titulaire de la chaire de recherche Sentinelle Nord en économie et santé du cerveau. Avant son arrivée à l’Université Laval, de 2017 à 2019, elle a été chercheure postdoctorale au James M. and Cathleen D. Stone Centre for the Study of Wealth Inequality, INSEAD, France, où elle a également été Marie-Curie fellow et Prestige fellow. Elle a complété un doctorat en économique à l’Université de Toronto, et détient une maîtrise en économique de l’Université Laval.
Maripier est membre facultaire associée au Centre canadien en économie de la santé, et siège sur le comité exécutif de l’Association canadienne d’économie de la santé.
Vittorio Nicoletta; Angel Ruiz; Valérie Bélanger; Thomas Paccalet; Maripier Isabelle; Michel Maziade
Dans: PLOS Ment Health, vol. 2, no 5, p. e0000327, 2025, ISSN: 2837-8156.
@article{pmid41661916,
title = {Analyzing service descriptors and patients' clinical characteristics may help understand heterogeneity in long-term trajectory of patients with schizophrenia, bipolar and major depressive disorder},
author = {Vittorio Nicoletta and Angel Ruiz and Valérie Bélanger and Thomas Paccalet and Maripier Isabelle and Michel Maziade},
doi = {10.1371/journal.pmen.0000327},
issn = {2837-8156},
year = {2025},
date = {2025-01-01},
journal = {PLOS Ment Health},
volume = {2},
number = {5},
pages = {e0000327},
abstract = {One major obstacle to advancing research and treatment for major psychiatric disorders is their substantial within-diagnosis heterogeneity in patient lifetime trajectories. Adapted research methods such as cluster analysis to define subgroups of patients are currently used. However few studies have included service delivery descriptors in cluster analysis to investigate the determinants of heterogeneity in long-term trajectories. The aim of this study was to test whether patterns of service delivery could help in defining subgroups in terms of trajectories and clinical profiles in schizophrenia, bipolar disorder or major depressive disorder patients. Hierarchical Agglomerative Clustering (HAC) algorithms were used on a sample extracted from a Quebec government (Canada) transactional database to group and classify patients according to their interactions with the service delivery system. The resulting clusters were analyzed using statistical tools to characterize service trajectories. We observed three distinct trajectories that were not specific to any one of the three lifetime psychiatric diagnoses. Clusters were particularly affected by varying rates of clinician changes across the trajectory and changes of diagnoses. Results suggest that incorporating service delivery characteristics in future longitudinal studies of heterogeneity might be useful as a complement to studies that solely examine patients' clinical features. The inclusion of service delivery elements may also be a useful tool for acquiring knowledge to adapt services to patients' needs in public mental health and mental health economics research.},
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Philip DeCicca; Maripier Isabelle; Natalie Malak
How do physicians respond to new medical research? Article de journal
Dans: Health Econ, vol. 33, no 10, p. 2206–2228, 2024, ISSN: 1099-1050.
@article{pmid38970311,
title = {How do physicians respond to new medical research?},
author = {Philip DeCicca and Maripier Isabelle and Natalie Malak},
doi = {10.1002/hec.4879},
issn = {1099-1050},
year = {2024},
date = {2024-10-01},
journal = {Health Econ},
volume = {33},
number = {10},
pages = {2206--2228},
abstract = {What happens when the findings of a prominent medical study are overturned? Using a medical trial on breech births, we estimate the effect of the reversal of such a medical study on physician choices and infant health outcomes. Using the United States Birth Certificate Records from 1995 to 2010, we employ a difference-in-differences estimator for C-sections, low Apgar, and low birth weight measures. We find that the reversal of a multi-site, high profile, randomized control trial on the appropriate delivery of term breech births, the Term Breech Trial, led to a 15%-23% decline in C-sections for such births at a time when the overall trend in C-sections was rising. We find our largest estimated effects amongst traditionally disadvantaged groups (i.e., non-white, and minimal education). However, we do not find that such a change in practice had significant impacts on infant health. Contrary to prior studies, we find that physicians updated their beliefs quickly, and do indeed adjust to new medical research, particularly young physicians, prior to mandatory policy or professional guidelines.},
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pubstate = {published},
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Meriem Bahda; Jasmin Ricard; Simon L Girard; Michel Maziade; Maripier Isabelle; Alexandre Bureau
Multivariate extension of penalized regression on summary statistics to construct polygenic risk scores for correlated traits Article de journal
Dans: HGG Adv, vol. 4, no 3, p. 100209, 2023, ISSN: 2666-2477.
@article{pmid37333772,
title = {Multivariate extension of penalized regression on summary statistics to construct polygenic risk scores for correlated traits},
author = {Meriem Bahda and Jasmin Ricard and Simon L Girard and Michel Maziade and Maripier Isabelle and Alexandre Bureau},
doi = {10.1016/j.xhgg.2023.100209},
issn = {2666-2477},
year = {2023},
date = {2023-07-01},
journal = {HGG Adv},
volume = {4},
number = {3},
pages = {100209},
abstract = {Genetic correlations between human traits and disorders such as schizophrenia (SZ) and bipolar disorder (BD) diagnoses are well established. Improved prediction of individual traits has been obtained by combining predictors of multiple genetically correlated traits derived from summary statistics produced by genome-wide association studies, compared with single trait predictors. We extend this idea to penalized regression on summary statistics in Multivariate Lassosum, expressing regression coefficients for the multiple traits on single nucleotide polymorphisms (SNPs) as correlated random effects, similarly to multi-trait summary statistic best linear unbiased predictors (MT-SBLUPs). We also allow the SNP contributions to genetic covariance and heritability to depend on genomic annotations. We conducted simulations with two dichotomous traits having polygenic architecture similar to SZ and BD, using genotypes from 29,330 subjects from the CARTaGENE cohort. Multivariate Lassosum produced polygenic risk scores (PRSs) more strongly correlated with the true genetic risk predictor and had better discrimination power between affected and non-affected subjects than previously published sparse multi-trait (PANPRS) and univariate (Lassosum, sparse LDpred2, and the standard clumping and thresholding) methods in most simulation settings. Application of Multivariate Lassosum to predict SZ, BD, and related psychiatric traits in the Eastern Quebec SZ and BD kindred study revealed associations with every trait stronger than those obtained with univariate sparse PRSs, particularly when heritability and genetic covariance depended on genomic annotations. Multivariate Lassosum thus appears promising to improve prediction of genetically correlated traits with summary statistics for a selected subset of SNPs.},
keywords = {},
pubstate = {published},
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}
Nancy Côté; Yasmine Frikha; Andrew Freeman; Sergio Cortez Ghio; Maude Laberge; Maripier Isabelle; Arnaud Duhoux; Jean-Louis Denis; Emmanuelle Jean; Sébastien Binette
Evaluation of an interprofessional primary healthcare team as a new model of primary care in Quebec: a protocol for a type 2 effectiveness-implementation hybrid study Article de journal
Dans: BMJ Open, vol. 13, no 5, p. e072006, 2023, ISSN: 2044-6055.
@article{pmid37253499,
title = {Evaluation of an interprofessional primary healthcare team as a new model of primary care in Quebec: a protocol for a type 2 effectiveness-implementation hybrid study},
author = {Nancy Côté and Yasmine Frikha and Andrew Freeman and Sergio Cortez Ghio and Maude Laberge and Maripier Isabelle and Arnaud Duhoux and Jean-Louis Denis and Emmanuelle Jean and Sébastien Binette},
doi = {10.1136/bmjopen-2023-072006},
issn = {2044-6055},
year = {2023},
date = {2023-05-01},
journal = {BMJ Open},
volume = {13},
number = {5},
pages = {e072006},
abstract = {INTRODUCTION: One family medicine group (FMG) in Quebec has commenced a 5-year pilot project, which is herein referred to as the model, to implement a patient-centred model based on interprofessional care and the optimal use of healthcare providers' practice scopes. A research project will be conducted to: (1) assess this model's effect on the FMG's operational performance, and its users' resource utilisation at the public health system level; (2) investigate its optimisation with respect to professional roles, interprofessional teamwork and patient-centredness and (3) document users' experience with the model. The aim of this article is to describe the protocol that will be used for this research.nnMETHODS AND ANALYSIS: A hybrid implementation approach (type 2 model) will be used. We will collect both quantitative and qualitative data. Regarding the quantitative dimension, and because this is a single-unit intervention study, we will use either or both synthetic control methods and one-sample generalised linear models for analyses at the FMG level. To evaluate the broader impact of on the public health system, we will use mixed-effects models and propensity score matching methods. Regarding the qualitative research dimension, using an interpretative descriptive approach, we will document users' experience and identify the factors that optimise professional scopes of practice, collaborative practices and patient-centredness. We will conduct individual in-depth semistructured interviews with healthcare providers, administrative staff, stakeholders involved in the model implementation and patients.nnETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of the Sectoral Research in Population Health and Primary Care of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (#2019-1503). The results of the investigation will be presented to the stakeholders involved in the advisory committees and at several scientific conferences. Manuscripts will be submitted to peer-reviewed journals.},
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Jill Furzer; Maripier Isabelle; Boriana Miloucheva; Audrey Laporte
Public drug insurance, moral hazard and children’s use of mental health medication: Latent mental health risk-specific responses to lower out-of-pocket treatment costs Article de journal
Dans: Health Econ, vol. 32, no 2, p. 518–538, 2023, ISSN: 1099-1050.
@article{pmid36408897,
title = {Public drug insurance, moral hazard and children's use of mental health medication: Latent mental health risk-specific responses to lower out-of-pocket treatment costs},
author = {Jill Furzer and Maripier Isabelle and Boriana Miloucheva and Audrey Laporte},
doi = {10.1002/hec.4631},
issn = {1099-1050},
year = {2023},
date = {2023-02-01},
journal = {Health Econ},
volume = {32},
number = {2},
pages = {518--538},
abstract = {Studies have shown that reducing out-of-pocket costs can lead to higher medication initiation rates in childhood. Whether the cost of such initiatives is inflated by moral hazard issues remains a question of concern. This paper looks to the implementation of a public drug insurance program in Québec, Canada, to investigate potential low-benefit consumption in children. Using a nationally representative longitudinal sample, we harness machine learning techniques to predict a child's risk of developing a mental health disorder. Using difference-in-differences analyses, we then assess the impact of the drug program on children's mental health medication uptake across the distribution of predicted mental health risk. Beyond showing that eliminating out-of-pocket costs led to a 3 percentage point increase in mental health drug uptake, we show that demand responses are concentrated in the top two deciles of risk for developing mental health disorders. These higher-risk children increase take-up of mental health drugs by 7-8 percentage points. We find even stronger effects for stimulants (8-11 percentage point increases among the highest risk children). Our results suggest that reductions in out-of-pocket costs could achieve better uptake of mental health medications, without inducing substantial low-benefit care among lower-risk children.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Nicolas R-Turgeon; Marie-Hélène Gagné; Maripier Isabelle
Association between child welfare reporting rates and the developmental vulnerability of kindergarten children at the neighborhood level Article de journal
Dans: Child Abuse Negl, vol. 132, p. 105790, 2022, ISSN: 1873-7757.
@article{pmid35868171,
title = {Association between child welfare reporting rates and the developmental vulnerability of kindergarten children at the neighborhood level},
author = {Nicolas R-Turgeon and Marie-Hélène Gagné and Maripier Isabelle},
doi = {10.1016/j.chiabu.2022.105790},
issn = {1873-7757},
year = {2022},
date = {2022-10-01},
journal = {Child Abuse Negl},
volume = {132},
pages = {105790},
abstract = {BACKGROUND: In Canada, more than one in four children are considered vulnerable in at least one domain of development when they enter kindergarten. Recent studies have suggested that this ratio is higher among those who were previously maltreated. However, little is known about this associations at the neighborhood level, although it may be an interesting way to identify risk areas and highlight child welfare system data to prevent public health issues.nnOBJECTIVE: Using the census tract as the unit of measurement, this study examines the association between the proportions of vulnerable children in different domains of development upon entering kindergarten, and four indicators of child maltreatment (CM) among 0-5 year olds.nnPARTICIPANTS, SETTING AND METHOD: This study is based on the secondary use of data from a survey on the development of kindergartners carried out in 2017, combined with data from child welfare records for that same year. The data have been aggregated on the basis of 759 census tracts located in four health regions of Quebec, Canada.nnRESULTS: The results of spatial regression analyses show that all indicators of maltreatment are positively and significantly associated with each indicator of developmental vulnerability. The size of these associations varies according to the indicators used (β = 0.192, p < .05 to β = 1.587, p < .001).nnCONCLUSION: The results highlight the link between CM and school readiness, including potential externalities on neighborhood children. Neighborhoods at high risk of maltreatment could help identify areas with high rate of vulnerable children in early childhood.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Annie LeBlanc; Marie Baron; Patrick Blouin; George Tarabulsy; Francois Routhier; Catherine Mercier; Jean-Pierre Despres; Marc Hébert; Yves De Koninck; Caroline Cellard; Delphine Collin-Vézina; Nancy Côté; Émilie Dionne; Richard Fleet; Marie-Hélène Gagné; Maripier Isabelle; Lily Lessard; Matthew Menear; Chantal Merette; Marie-Christine Ouellet; Marc-André Roy; Marie-Christine Saint-Jacques; Claudia Savard;
Dans: BMJ Open, vol. 12, no 4, p. e048749, 2022, ISSN: 2044-6055.
@article{pmid35379610,
title = {For a structured response to the psychosocial consequences of the restrictive measures imposed by the global COVID-19 health pandemic: the MAVIPAN longitudinal prospective cohort study protocol},
author = {Annie LeBlanc and Marie Baron and Patrick Blouin and George Tarabulsy and Francois Routhier and Catherine Mercier and Jean-Pierre Despres and Marc Hébert and Yves De Koninck and Caroline Cellard and Delphine Collin-Vézina and Nancy Côté and Émilie Dionne and Richard Fleet and Marie-Hélène Gagné and Maripier Isabelle and Lily Lessard and Matthew Menear and Chantal Merette and Marie-Christine Ouellet and Marc-André Roy and Marie-Christine Saint-Jacques and Claudia Savard and },
doi = {10.1136/bmjopen-2021-048749},
issn = {2044-6055},
year = {2022},
date = {2022-04-01},
journal = {BMJ Open},
volume = {12},
number = {4},
pages = {e048749},
abstract = {INTRODUCTION: The COVID-19 pandemic and associated restrictive measures have caused important disruptions in economies and labour markets, changed the way we work and socialise, forced schools to close and healthcare and social services to reorganise. This unprecedented crisis forces individuals to make considerable efforts to adapt and will have psychological and social consequences, mainly on vulnerable individuals, that will remain once the pandemic is contained and will most likely exacerbate existing social and gender health inequalities. This crisis also puts a toll on the capacity of our healthcare and social services structures to provide timely and adequate care. The MAVIPAN (Ma vie et la pandémie/ My Life and the Pandemic) study aims to document how individuals, families, healthcare workers and health organisations are affected by the pandemic and how they adapt.nnMETHODS AND ANALYSIS: MAVIPAN is a 5-year longitudinal prospective cohort study launched in April 2020 across the province of Quebec (Canada). Quantitative data will be collected through online questionnaires (4-6 times/year) according to the evolution of the pandemic. Qualitative data will be collected with individual and group interviews and will seek to deepen our understanding of coping strategies. Analysis will be conducted under a mixed-method umbrella, with both sequential and simultaneous analyses of quantitative and qualitative data.nnETHICS AND DISSEMINATION: MAVIPAN aims to support the healthcare and social services system response by providing high-quality, real-time information needed to identify those who are most affected by the pandemic and by guiding public health authorities' decision making regarding intervention and resource allocation to mitigate these impacts. MAVIPAN was approved by the Ethics Committees of the Primary Care and Population Health Research Sector of CIUSSS de la Capitale-Nationale (Committee of record) and of the additional participating institutions.nnTRIAL REGISTRATION NUMBER: NCT04575571.},
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pubstate = {published},
tppubtype = {article}
}
Maripier Isabelle; Mark Stabile
Local inequality and departures from publicly provided health care in Canada Article de journal
Dans: Health Econ, vol. 29, no 9, p. 1031–1047, 2020, ISSN: 1099-1050.
@article{pmid32558020,
title = {Local inequality and departures from publicly provided health care in Canada},
author = {Maripier Isabelle and Mark Stabile},
doi = {10.1002/hec.4117},
issn = {1099-1050},
year = {2020},
date = {2020-09-01},
journal = {Health Econ},
volume = {29},
number = {9},
pages = {1031--1047},
abstract = {This paper examines the relationship between changes in income inequality and the provision of resources in a health care system (the public-private mix). Specifically, we investigate whether increases in income inequality, as separate from overall income levels and growth, have changed the availability of both private clinics and privately financed physicians in a context where the dominant market player is the public system. Our findings provide reasonable evidence that increases in income inequality have led to substantial increases in both. We find that moving from median level of inequality across neighborhoods to the top 1% level of inequality increases the probably of a private clinic by 40% and the probability of having physicians who have opted out of the public system by 170%.},
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pubstate = {published},
tppubtype = {article}
}
