Nearly one in four Canadians worried about affording health care

There’s much hand-wringing about the results of a new Commonwealth Fund International Health Policy Survey sponsored in part by the soon-to-be defunct Health Council of Canada.

While the media focus is on the bigger failures indicated by the survey, the question is, how much of it is even accurate?

Taken between March and June 2013, the survey includes a larger than usual sampling of Canadians thanks to the governments of Alberta, Ontario and Quebec paying to expand their sample sizes to more than 1,000 respondents each. That’s a good sampling for opinion accuracy, but that doesn’t necessarily translate to an accurate profile of Canada’s health system.

While the results may indicate some overall general trends, there are significant contradictions in the results that should throw up caution flags.

On the one hand Canadians have significantly more confidence in their health system than they did nearly a decade ago and give very high ratings to the quality of care. Fifty per cent of Ontarians believe the system works pretty well and only needs minor changes – that’s well above the national average of 42 per cent.

On the other hand the report indicates access to care has not substantially improved nor has the system become better integrated or patient-centered. Some of these poor results are also at odds with actual performance tracking.

For example, 23 per cent of Ontarians say they have to wait four hours or more just to be treated in an emergency department (ED). The province reports TOTAL time spent in the ED for minor conditions is an average of 2.1 hours and for nine out of ten patients 3.9 hours. How can 23 per cent wait four hours just to be treated when 90 per cent of Ontario patients who are the lowest on the triage scale can been diagnosed, treated, and discharged in less time than that? Maybe it just felt like four hours or more.

Demographically the population profile is similar from province to province, except for Alberta whose survey respondents appear to be younger and wealthier. Half of Alberta respondents said they earned more than $77,000 per year — that could definitely skew results.

In a country that prides itself on its public Medicare system, there are some alarming trends that suggest we are paying more out-of-pocket and subsequently becoming more concerned about our ability to afford the care we need.

Fourteen per cent of Canadians said they spent more than $1,000 out-of-pocket for health care in the past year. Nationally eight per cent said they didn’t fill a prescription because they couldn’t afford it. Ontario did worse at 11 per cent in prescription non-compliance. 21 per cent of Canadians – more than one in five — skipped dental care because of cost. Overall nearly one in four Canadians (24%) say they are concerned about being able to pay for all the care they need should they become seriously ill.

The concern about the cost of drugs may be a result of how many prescriptions we take. Of 11 comparator countries, Canada ranks fourth in the number of prescription medications taken on a regular or ongoing basis.

Fewer Ontarians have supplementary health insurance than their counterparts in most other provinces. Only BC and Quebec were worse.

Ontario does better than all other provinces except for BC when it comes to available physicians or group clinics. Four per cent of Ontarians said they had no regular doctor or regular place of care. In Quebec it was 15 per cent.

After hours care – other than a hospital emergency department – remains difficult to access across Canada, although again Ontario and BC are doing the best.

Most still cannot get into a family doctor in a timely manner. Only 42 per cent of Ontarians said they would get in to see their doctor either the same or next day. This compares to 76 per cent in Germany and 72 per cent in New Zealand.

While Ontario’s Community Care Access Centres would like to be seen as system navigators, it is the family doctors most patients say helps coordinate their care.

Maybe Ontarians would want to rethink that.

Respondents said that one-in-three (33%) Ontario doctors were not informed and up-to-date about their care in a hospital emergency department. More than one-in-three said their family doctors didn’t know important information about their medical history. That could be because 46 per cent of Ontarians said their regular doctor doesn’t spend enough time with them during visits. Perhaps part of that time should be spent on joint doctor-patient decision-making. Only 64 per cent of Ontarians said their regular doctor spends as much time as they would like in joint decision-making about their course of treatment.

There was a vast difference in respondents who said that they had a medication review upon discharge from hospital. In Nova Scotia 35 per cent said they did. In Ontario it was only 13 per cent. Only one in five Canadians said their doctor or pharmacists has reviewed their medications within the last 12 months.

Only one in three (33%) Ontarians say they have easy access to test results compared to almost half of patients (49%) in Quebec.

As much as Canadians support the idea of preventative care, fewer than half of Ontarians (46%) have talked to their family physician about healthy eating, and 41 per cent about physical exercise. That could be our fault. Sixty-two per cent of Ontarians have said no to a flu shot, 6 per cent of women between the ages of 18-70 have never had a pap test and 26 per cent of women between the ages of 40-74 have never had a mammogram. One in five Ontarians have never had their cholesterol checked. Reminders for preventative care are not routine in most parts of Canada – Newfoundland and Quebec do the best on that list.

Ontarians do much better for colon cancer screening – only 26 per cent of respondents aged 50 years and older said they had never been screened compared to 49 per cent in Quebec.

With telephone surveys there is always a gulf between what people say and what their actual experience has been. Some may not entirely understand the question at hand while others may have simply forgot. Can you remember everything you discussed during the last visit with your general practitioner?

Perhaps an interesting question would be to ask patients how many take notes during their visit with a family doctor? What do they do to remember?

Several years ago we polled Ontarians about Pharmacare only to discover many thought it had something to do with farms. Most didn’t know what it meant. We wonder how most respondents dealt with many of these detailed medical questions.

Hospitals have been the target for much of Ontario’s reform efforts, but much of the data from the survey suggests attention would be better focussed on what happens when patients visit their family doctor or clinic.

If you think these kinds of surveys are useful, then you should be upset that the Harper government is pulling the plug on the Health Council of Canada. The Health Council was created as a result of the 2003 First Minister’s Accord on Health Care Renewal. Instead of negotiating a new 10-year accord, the Federal government abdicated any responsibility and simply told the provinces how much money they would receive in transfers going forward – no strings attached.