Health Care in Canada Survey 2004

Health Care in Canada Survey 2004

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Health Care in Canada Partners Association of Canadian Academic Healthcare OrganizationsAssociation of Canadian Academic Healthcare Organizations

Canadian Association for Community CareCanadian Association for Community Care

Canadian College of Healthcare ExecutivesCanadian College of Healthcare Executives

Canadian Healthcare AssociationCanadian Healthcare Association

Canadian Homecare AssociationCanadian Homecare Association

Canadian Medical AssociationCanadian Medical Association

Canadian Nursing AssociationCanadian Nursing Association

Canadian Pharmacists AssociationCanadian Pharmacists Association

Canadian Public Health AssociationCanadian Public Health Association

Health Charities Coalition of CanadaHealth Charities Coalition of Canada

Merck Frosst Canada Ltd.Merck Frosst Canada Ltd.

POLLARA Research POLLARA Research

Rogers Media Rogers Media

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Table of Contents Methodology

Overview of the Health Care System

Views on the September 2004 Federal-Provincial Health Care Deal

Improving Access

Promoting and Protecting Health

Supporting Innovation

Increasing Accountability

Conclusions

4

MethodologySurvey results are based on telephone interviews with nationally representative samples of the Canadian public, doctors, nurses, pharmacists and health administrators.

Fielding was conducted between October 20th and November 3rd, 2004.

Groups Sample Size Margin of Error

Canadian Public 1,034 + 3.1%

Doctors 200 + 7.1%

Nurses 201 + 7.1%

Pharmacists 200 + 7.1%

Health Administrators 210 + 7.1%

Questionnaires were developed by POLLARA working in close consultation with the HCIC partners.

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Overview of the Health Care System

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Most Important Issue Facing Canada: Tracking

Q: In your opinion, what is the single most important issue facing Canada today?

0

0.1

0.2

0.3

0.4

0.5

1stQtr95

1stQtr96

1stQtr97

1stQtr98

1stQtr99

1stQtr00

1stQtr01

1stQtr02

1stQtr03

1stQtr04

Health Care (40%)Concerns About Politicians/Govt (5%)Deficit/Government Spending (5%)Economy (5%)Unemployment (4%)Taxes (3%)Environment/Pollution (2%)

5% Politicians

2% Environment3% Taxes4% Unempl

40% Health

5% Deficit5%Economy

Source: Perspectives Canada – Q3 2004

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‘Very Concerned’: Tracking

15%

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

70%

75%

3rdQtr97

1stQtr98

1stQtr99

1stQtr00

1stQtr01

1stQtr02

1stQtr03

2ndQtr03

3rdQtr03

4thQtr03

1stQtr04

3tdQtr04

Standard of health care (58%)Standard of education (48%)State of the environment (45%)Level of crime in community (30%)Canada's security from terrorist attacks (29%)

Q: Now thinking more generally, would you say you are very concerned, somewhat concerned, not too concerned, or not at all concerned about the following issues? How about: (READ AND ROTATE)

% Very Concerned

Source: Perspectives Canada – Q3 2004

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Tracking of Canadians Confidence in the Health Care

System

Q:Overall, would you say that your confidence in the Canadian health system is rising or falling, or is it about the same as it ever was?

1998

1999

2000

2001

2002

2003

Spring 2004

Fall 2004

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Confidence of Stakeholders in Canadian Health Care System

Q: Overall, would you say that your confidence in the Canadian health system is rising or falling, or is it about the same as it ever was?

Public

Doctors

Nurses

Pharmacists

Managers

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Proportion With ‘Falling Confidence’ in Canadian Health System is

Declining

Q: Overall, would you say that your confidence in the Canadian health system is rising or falling, or is it about the same as it ever was?

47%51%

58%54%

51%55%

59%

41%

54%65%61%59%

70%

53%

49%

68%64%

58%62%

33%

51%

31%

47%

45%47%

21%

30%

47%50%

0%

20%

40%

60%

80%

100%

1998 1999 2000 2001 2002 2003 2004

Public Doctors Nurses Pharmacists Managers

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Canadians’ Views on Health Care

System Reform

Q: What approach would you say that Canada’s health system requires at present - a complete rebuilding from the ground up, some fairly major repairs or some minor tuning up, or is everything fine the way it is?

1998

1999

2000

2001

2002

2003

2004 – Spring

2004 - Fall

Complete Rebuilding

Fairly Major Repairs

Minor Tuning Up

Everything's Fine

Source: HCIC 2004 – Update; POLLARA Omnibus Sept ‘04

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Views of The Health Care System in Five Nations - 1998 to 2004

Percent saying: AUS CAN NZ UK US

Only Minor Changes Needed 2004 21 21 19 26 16 2001 25 21 18 21 18 1998 19 20 9 25 17

Rebuild Completely

2004 23 14 19 13 33 2001 19 18 20 18 28 1998 30 23 32 14 33

Source: The Commonwealth Fund 2004 International Health Policy Survey of Primary Care in Five Countries; Conducted by Harris Interactive and subcontractors; March – May 2004

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Views on the September 2004 Federal-Provincial Health Care

Deal

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Impact of Health Deal

71% 24% 1%3%

57% 38% 3%3%

55% 35% 4% 7%

52% 37% 5% 5%

52% 33% 9% 7%

0% 20% 40% 60% 80% 100%

Managers

Pharmacists

Nurses

Doctors

Public

Improve Have No Impact Worsen DK/Ref.

Q: In your opinion, what impact will the September 2004 Health Deal reached by the Premiers and the Prime Ministers have? Do you think it will significantly improve, improve, have no impact, worsen or significantly worsen Canadians’ access to timely, quality health care?

15

Managers Views on Health Care

Deal Funding

Sufficient Money to Address the

Capital Funding

Sufficient Money forWait Times For

Key Services

Q: Do you think the healthcare deal recently agreed upon by the first ministers provides sufficient dollars to address the capital funding needs in your region/facility?

Q: Do you think the agreement between the first ministers provides sufficient dollars to address the wait times for surgeries, diagnostics or other key services in your region/facility?

16

Improving Access

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Canadians’ Satisfaction with Health Care Access in Home

and Community

Q: Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied with access to care in the home or community?

2000

2001

2002

2003

2004

VerySatisfied

SomewhatSatisfied

SomewhatDissatisfied

VeryDissatisfied

DK/Ref.

Total Satisfied

47%

48%

48%

48%

49%

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Canadians’ Satisfaction with Health Care Access in Home

and Community: Demographics

45% 40% 15%

54% 35% 11%

45% 45% 10%

52% 36% 11%

56% 34% 11%

36% 43% 21%

60% 28% 13%

49% 38% 13%

0% 20% 40% 60% 80% 100%

Women

Men

BC

Prairies

Ontario

Quebec

Atlantic

Total

Satisfied Dissatisfied DK/Ref

Q: Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied with access to care in the home or community?

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Timeliness of Access to Care

Q: Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied with the following aspects of today’s health care system? (READ AND ROTATE) ... Timeliness of access to care

2000

2001

2002

2003

Spring 2004

Source: HCIC 2004 - Update

Total Satisfied

42%

38%

43%

43%

46%

VerySatisfied

SomewhatSatisfied

SomewhatDissatisfied

VeryDissatisfied

DK/Ref.

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Canadians More Pessimistic About Improvements in Access

to Care

Q: Over the next five years, do you believe that Canadians’ access to timely, quality health care will significantly improve, improve somewhat, worsen somewhat or significantly worsen?

2002

2003

Spring 2004

Source: HCIC 2004 - Update

Total Improved

34%

47%

37%

SignificantlyImprove

ImproveSomewhat

WorsenSomewhat

SignificantlyWorsen

DK/Ref.

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Summary of Health Care Human Resources

Q: Do you believe that Canada has more than enough, enough, or not enough of each of the following skilled health care professionals to meet our population’s needs? (READ AND ROTATE)

2%11%

86%

1% 2%

13%

81%

4% 6%

66%

20%

8%19%

33%

21%26%

0%

20%

40%

60%

80%

100%

Doctors Nurses Pharmacists Health Care Managers

More Than Enough Enough Not Enough DK/Ref.

DoctorsMore Than Enough=1%Enough=10%Not Enough=89%

Ge

ne

ral

Pu

bli

c T

hin

ks

NursesMore Than Enough=1%Enough=6%Not Enough=92%

PharmacistsMore Than Enough=1%Enough=11%Not Enough=88%

ManagersMore Than Enough=4%Enough=52%Not Enough=40%

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Doctors’ Views on Solutions to Physician Shortage

Increase MedicalSchool Enrolment

Better Models OfHealthcare Delivery

More InternationalMedical Graduates

Train & DelegateTo Professionals

VeryEffective

SomewhatEffective

Not VeryEffective

Not At AllEffective

DK/Ref.

Q: How effective would you say the following options would be in providing a sustainable solution to address Canada’s physician shortage: very effective, somewhat effective, not very effective, not at all effective?

Total Effective

88%

76%

64%

69%

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Doctors’ View of Role of Physicians – Compared to 10

Years Ago

Q: Thinking of how patients perceive the role of physicians today, compared to 10 years ago, to what extent do you agree with the following statements, on a 10-point scale where 1 means Totally Disagree and 10 means Totally Agree?

Patients see physicians asprimary HC provider

Physician are now one of many components, as opposed to the sole source, in their

approach to health and wellness

Mass information and the focus on health awareness has improved the traditional

patient/physician relationship

Mass information and the focus on health awareness has threatened the traditional

patient/physician relationship

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Pharmacists’ View on Role of Pharmacists

Q: To what extent do you agree with the following statements, on a 10-point scale where 1 means Totally Disagree and 10 means Totally Agree:

Pharmacists should play an integral part in providing medication services

to patients receiving care at home

Pharmacists should have greater role in choosing the appropriate

prescription medications for patients

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Promoting and Protecting Health

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Promotion of Wellness andDisease Prevention

Q: Do you strongly agree, somewhat agree, somewhat disagree or strongly disagree that Canadians are encouraged/motivated to promote wellness and prevent disease?

Public

Doctors

Nurses

Pharmacists

Managers

StronglyAgree

SomewhatAgree

SomewhatDisagree

StronglyDisagree

DK/Ref.

Total Agree

71%

64%

68%

73%

55%

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Supporting Innovation

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Increase Public Sector Funding for Health Research

2004

2003

2004

2003

2004

2003

2004

2003

2004

2003

Q: Health research can include research into medical treatments as well as the best ways to provide care and manage the health care system. Would you say that you strongly agree, agree, are neutral, disagree, or strongly disagree with the following statements: (READ AND ROTATE)

There should be increased public sector funding for health research, such as at universities, teaching hospitals and other not-for-profit organizations.

StronglyAgree

Agree Neutral Disagree StronglyDisagree

DK/Ref.

Public

Doctors

Nurses

Pharmacists

Managers

Total Agree

81%83%

86%82%

82%81%

88%85%

84%80%

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Incentives to Encourage More Private Sector Investment

2004

2003

2004

2003

2004

2003

2004

2003

2004

2003

Q: Health research can include research into medical treatments as well as the best ways to provide care and manage the health care system. Would you say that you strongly agree, agree, are neutral, disagree, or strongly disagree with the following statements: (READ AND ROTATE)

Incentives should be put in place to encourage more private sector investments in health research such as at universities, teaching hospitals and other not-for-profit organizations

StronglyAgree

Agree Neutral Disagree StronglyDisagree

DK/Ref.

Public

Doctors

Nurses

Pharmacists

Managers

Total Agree

70%76%

79%75%

78%69%

86%78%

75%70%

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Support for Contracting Out Publicly Covered Services

Q: Do you strongly support, support, oppose or strongly oppose allowing the government to be able to contract out the delivery of publicly covered services to private clinics, for instance having medicare pay for knee surgery at a private clinic rather than a public hospital?

StronglySupport

Support Oppose StronglyOppose

DK/Ref.

2004

2003

2004

2003

2004

2003

2004

2003

2004

2003

Public

Doctors

Nurses

Pharmacists

Managers

53%57%

61%55%

68%66%

51%58%

66%66%

Total Support

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Support for Contracting Out Publicly Covered Services:

Demographics

49% 46% 4%

57% 38% 5%

53% 41% 6%

55% 41% 5%

43% 52% 4%

69% 28% 3%

45% 47% 8%

53% 42% 4%

0% 20% 40% 60% 80% 100% 120%

Women

Men

BC

Prairies

Ontario

Quebec

Atlantic

Total

Strongly Support/Support Strongly Oppose/Oppose DK/Ref

Q: Do you strongly support, support, oppose or strongly oppose allowing the government to be able to contract out the delivery of publicly covered services to private clinics, for instance having medicare pay for knee surgery at a private clinic rather than a public hospital?

32

Views on Paying for Quicker Access

Q: Do you strongly support, support, oppose or strongly oppose individuals being allowed to pay out of their own pocket for quicker access to health services that are currently funded under the public system?

Total Support

35%

Total Support

59%

Total Support

41%

Total Support

61%

Total Support

45%

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Paying for Quicker Access: Regional Views

45% 53% 2%

35% 62% 3%

24% 72% 4%

45% 52% 3%

37% 60% 4%

35% 62% 3%

0% 20% 40% 60% 80% 100% 120%

BC

Prairies

Ontario

Quebec

Atlantic

Total

Strongly Support/Support Strongly Oppose/Oppose DK/Ref

Q: Do you strongly support, support, oppose or strongly oppose individuals being allowed to pay out of their own pocket for quicker access to health services that are currently funded under the public system?

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Canadians Willing to Pay

Q: Would you be willing to pay more, either out-of-pocket or tax payments, to increase the range of services offered or the improve timeliness of care provided by the health care system?

2002

2003

Spring 2004

Source: HCIC 2004 - Update

Total Yes

69%

60%

54%

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Canadians’ Views on Dealing with Health Care Shortfalls

Q: If the governments through taxation could not cover all of the costs for all health services, they might have to make choices as to how to deal with the shortfall. Would you strongly support, support, oppose or strongly oppose each of the following choices? (READ AND ROTATE)

Restricting the Range ofServices That Are Offered

Asking Patients to Pay forPart of the Cost of Services

Health Care Tax Linked to Income

Cut Other Gov. Services and Direct to Health Care

2004

2003

2004

2003

2004

2003

2004

2003

Total Support

21% 73%

19% 76%

34% 62%

39% 58%

41% 55%

46% 51%

65% 27%

67% 28%

Total Oppose

36

Support for Innovation in Health Care Delivery (Compared

to 2003)

Q: Do you strongly support, support, oppose or strongly oppose each of the following policies to increase access to health care professionals? (READ AND ROTATE)

-5 -3 -6 +4 -8 -3 -1 n/c n/c -1 -3 -6 -1 -1 -8

% Strongly/Support

37

Increasing Accountability

38

Making Sure Every Tax Dollar Intended for Health Care is

Spent on Health Care

4% 23% 36% 28% 6%3%

2% 20% 33% 34% 7% 5%

2%16% 35% 33% 12% 2%

4% 16% 29% 31% 15% 5%

7% 18% 30% 24% 16% 4%

0% 20% 40% 60% 80% 100%

Managers

Pharmacists

Nurses

Doctor

Public

Very Good Good Fair Poor Very Poor DK/Ref.

Q: Thinking of the additional funding that will be made available under the new Health Deal, do you believe that the government will do a very good, good, fair, poor or very poor job of each of the following? (READ AND ROTATE)

Making sure that every tax dollar intended for health care will be spent on health care

Total ‘Very Good

/Good/Fair’

55%

49%

53%

55%

63%

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Reporting to Canadians the Results of How Those Health Care

Dollars are Spent

6% 20% 42% 25% 6%2%

2%15% 42% 31% 8% 3%

1%16% 35% 34% 12% 2%

6% 19% 29% 28% 12% 6%

5% 18% 28% 29% 17% 4%

0% 20% 40% 60% 80% 100%

Managers

Pharmacists

Nurses

Doctor

Public

Very Good Good Fair Poor Very Poor DK/Ref.

Q: Thinking of the additional funding that will be made available under the new Health Deal, do you believe that the government will do a very good, good, fair, poor or very poor job of each of the following? (READ AND ROTATE)

Reporting to Canadians the results of how those health care dollars are spent.

Total ‘Very Good / Good’

23%

25%

17%

17%

26%

40

Awareness of Health Council of Canada

87% 13%

34% 66%

35% 65%

52% 47%

27% 71%

0% 20% 40% 60% 80% 100%

Managers

Pharmacists

Nurses

Doctor

Public

Yes No

Q: In 2004 the Health Council of Canada was formed to report to Canadians on the progress of health reforms in Canada. Their first report will be in January 2005. Have you heard of this council?

41

Top Priorities for Health Council – All Stakeholders

Q: In 2004 the Health Council of Canada was formed to report to Canadians on the progress of health reforms in Canada. Their first report will be in January 2005. What do you think the priorities of the council should be? (OPEN-ENDED)

42

Conclusions

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Conclusions Health care remains a top issue of concern for Canadians.

Confidence in the health care system is falling for a large proportion of the public. However, most of the professional stakeholders are not as pessimistic (except nurses). In fact one-quarter of health care managers report raising confidence in the system.

The Federal-Provincial health care deal is viewed as an improvement to system, with managers the most positive.

Access remains a concern, with less than half of Canadians are satisfied with health care access at home and in community. This remains unchanged over the last number of years.

The public and all stakeholder groups say there is a shortage of both doctors and nurses in the system.

Canadians (especially doctors and pharmacists) appear willing to accept alternative ways to deliver health care services, such as contracting out certain publicly funded services, but they are unwilling to accept cuts to services or having to pay more, either directly out of pocket or indirectly through a health care tax.

Meanwhile, while Canadians may accept increased private involvement in the delivery of services, a majority do not support being able to pay to jump the queue to receive quicker service.

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Conclusions Canadians and all providers groups support increasing public funding

and incentives for private funding of health research. Support for incentives for private funding has risen for all provider groups.

Canadians are looking for innovative solutions in how we deliver care before we seek additional personal contribution from them or restrict services we offer.

Canadians feel sceptical about how government will in ensuring money assigned for health care will be spent on health care, as well as in reporting to Canadians how health care dollars are spent.

Awareness of Health Council is highest among health care managers and doctors, and lowest among general public.

Assessing public and provider priorities for the Health Council will likely require more deliberative approaches combined with public polling.

Canadians are open to reforms and have expectations that the new Health Deal will improve things.

Health Care in Canada Survey 2004

Health Care in Canada Survey 2004