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Is Quebec a model of high-quality, affordable care?

Since the start of the pandemic, calls for universal child care have picked up steam.   Before pursuing this policy approach, however, there are important questions to answer. These questions pertain to all aspects of child care—accessibility, quality, and cost. Every family is different, and child care needs and desires vary. Will a federally funded, universal system be able to meet these needs? The pertinent question is if Quebec offers a model of high-quality, affordable care?

Topics: Family, Children

Quebec’s universal daycare system has been in place for twenty years, and yet high-quality care remains elusive.

While child-care research is plentiful, not all of it is created equal. The most rigorous academic research shows that the Quebec model struggles with the provision of high-quality child care. One such peer- reviewed study by economists Michael Baker, Jonathan Gruber, and Kevin Milligan in 2005 found that “children were worse off in the years following the introduction of the universal child care program.”1 In 2015, the same economists conducted another study concluding that “negative non-cognitive effects persisted to school ages, and also that cohorts with increased child care access subsequently had worse health, lower life satisfaction, and higher crime rates later in life.”2Another economist, Steven Lehrer, decided to test the findings of Baker, Gruber, and Milligan, thinking that he would not be able to replicate the results. Instead, he concluded, “The main result we found was that Baker, Gruber and Milligan’s work is 100 per cent correct. It’s robust.”3

Université du Québec à Montréal economist Pierre Fortin acknowledges the problem with low-quality care in Quebec but blames it on the problem of having “two tiers.”4 He writes, “The high-performance early childhood centres’ (CPE [Centres de la petite enfance]) network has been demonstrated to deliver positive cognitive, health and behavioural results on average, and to be effective in reducing the vulnerability of children of all income classes, but it absorbs only 1/3 of children.”5 Non-CPE care is blamed for low quality within the system. Yet two decades after implementation, non-CPE care is a necessity within Quebec’s system because of the inability to access the CPE spots.

Part of the challenge is that the term “quality” is not clearly or consistently defined in child-care literature, and the measurement of quality is biased toward institutional, state settings.

As one proponent put it, “Now that the early childhood care and education system is firmly established in Québec, and its existence is not in all likelihood threatened, . . . it is time to examine all the other issues that will contribute to improving the system.”6

Low-quality and mediocre care continue to plague this model despite its two decades of existence. Would we expect a national system to be better? If so, how?

Part of the challenge is that the term “quality” is not clearly or consistently defined in child-care litera- ture, and the measurement of quality is biased toward institutional, state settings. If a parent arranges child care between parents and extended family and adds in a babysitter three times a week, the quality of this care may be exemplary, but it cannot easily be measured. The authors of a recent memorandum pushing for Canada to adopt the Quebec model on a national scale concede this point: “We have, at this time, no understanding of the full ecosystem of care, particularly arrangements in unregulated care (how much is paid, how much unpaid, what kind of care, in what kind of physical setting, is offered) This is a major shortfall in necessary information with which to guide the evolution of policy-making and funding, through the period of pandemic ‘recovery’ and for years after.”7 This is a significant shortfall, indeed. Before spending tens of billions of dollars, the federal government must study the evidence on the current quality of all care versus the current quality of care in the Quebec model that it seeks to emulate.

One study that has attempted to evaluate the quality of all existing care is the NICHD Study of Early Child Care and Youth Development, a major, comprehensive, and collaborative effort by a team of researchers who tracked one thousand children across ten communities until age fifteen in the United States.8 It is the gold standard for examining quality of child care. The results of this study are complex. One of the researchers summarizes the risks and benefits:

The risks are (a) that more hours in (any kind of ) child care across the first 4 1/2 years of life are related to more problem behaviour from 54 months through first grade and less social competence and poorer academic work habits in third grade; and, independently, (b) that more time in child-care centers is related to higher levels of problem behaviour from 54 months through third grade. The benefit is that higher quality child care and more experience in centers predicts better cognitive, linguistic and academic-achievement functioning across the same lengthy developmental period. Critically, these effects of child care obtain when other aspects of child care are themselves taken into account (i.e., statistically controlled). Clearly, it is simplistic to speak in terms of child-care effects in general, as different features of child care appear to differentially impact different aspects of development.9

Of note are the findings pertaining to quantity of care being as important as quality of care. This interaction between quantity and quality of care is a conversation Canadians are not having. It is already known that introducing a provincial system in Quebec has increased the number of hours in care,10 which may mean fewer positive outcomes regardless of quality of care. The main point, however, is that an in-depth study, testing outcomes of various forms of child care over the long term, has not yet been done in Canada.11

That the Quebec model needs to improve quality is something that advocates of this system agree on and discuss at conferences.12 Why is Quebec not able to offer high quality to all children? How much more money is required to finally achieve high quality, and is this the system parents want and need? What would be required to achieve quality on a national scale? Do we even have a coherent, agreed-on standard of quality? Do we risk placing the interests of the state (that is, GDP enhancement and increased tax revenues) ahead of the interests of families and children?

The Takeaway

A national approach to child care cannot be based on a model that has been struggling to offer quality care for over twenty years. Peer-reviewed research should be our guide in better understanding the experiences of Quebec children, and further research ought to be done nationally to better understand the existing ecosystem of care.