1. Health Care in Canada Survey 2004

2. 2 Health Care in Canada Partners Association of Canadian Academic Healthcare Organizations Association of Canadian Academic Healthcare Organizations Canadian Association for Community Care Canadian Association for Community Care Canadian College of Healthcare Executives Canadian College of Healthcare Executives Canadian Healthcare Association Canadian Healthcare Association Canadian Homecare Association Canadian Homecare Association Canadian Medical Association Canadian Medical Association Canadian Nursing Association Canadian Nursing Association Canadian Pharmacists Association Canadian Pharmacists Association Canadian Public Health Association Canadian Public Health Association Health Charities Coalition of Canada Health Charities Coalition of Canada Merck Frosst Canada Ltd. Merck Frosst Canada Ltd. POLLARA Research POLLARA Research Rogers Media Rogers Media

3. 3 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. 4 Methodology Survey 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 20 th and November 3 rd, 2004. GroupsSample SizeMargin of Error Canadian Public1,034+ 3.1% Doctors200+ 7.1% Nurses201+ 7.1% Pharmacists200+ 7.1% Health Administrators210+ 7.1% Questionnaires were developed by POLLARA working in close consultation with the HCIC partners.

5. 5 Overview of the Health Care System

6. 6 Most Important Issue Facing Canada: Tracking Q: In your opinion, what is the single most important issue facing Canada today? 5% Politicians 2% Environment 3% Taxes 4% Unempl 40% Health 5% Deficit 5%Econom y Source: Perspectives Canada – Q3 2004

7. 7 Very Concerned: Tracking 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

8. 8 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

9. 9 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

10. 10 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?

11. 11 Canadians Views on Health Care System Reform Q:What approach would you say that Canadas 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

12. 12 Views of The Health Care System in Five Nations - 1998 to 2004 Percent saying: AUSCANNZUKUS Only Minor Changes Needed 2004 21 192616 2001 2521182118 1998 192092517 Rebuild Completely 2004 2314191333 2001 1918201828 1998 3023321433 Source: The Commonwealth Fund 2004 International Health Policy Survey of Primary Care in Five Countries; Conducted by Harris Interactive and subcontractors; March – May 2004

13. 13 Views on the September 2004 Federal-Provincial Health Care Deal

14. 14 Impact of Health Deal 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. 15 Managers Views on Health Care Deal Funding Sufficient Money to Address the Capital Funding Sufficient Money for Wait 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. 16 Improving Access

17. 17 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 Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied DK/Ref. Total Satisfied 47% 48% 49%

18. 18 Canadians Satisfaction with Health Care Access in Home and Community: Demographics 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?

19. 19 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 todays 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% 46% Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied DK/Ref.

20. 20 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% Significantly Improve Improve Somewhat Worsen Somewhat Significantly Worsen DK/Ref.

21. 21 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 populations needs? (READ AND ROTATE) Doctors More Than Enough=1% Enough=10% Not Enough=89% General Public Thinks Nurses More Than Enough=1% Enough=6% Not Enough=92% Pharmacists More Than Enough=1% Enough=11% Not Enough=88% Managers More Than Enough=4% Enough=52% Not Enough=40%

22. 22 Doctors Views on Solutions to Physician Shortage Increase Medical School Enrolment Better Models Of Healthcare Delivery More International Medical Graduates Train & Delegate To Professionals Very Effective Somewhat Effective Not Very Effective Not At All Effective DK/Ref. Q:How effective would you say the following options would be in providing a sustainable solution to address Canadas physician shortage: very effective, somewhat effective, not very effective, not at all effective? Total Effective 88% 76% 64% 69%

23. 23 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 as primary 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

24. 24 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

25. 25 Promoting and Protecting Health

26. 26 Promotion of Wellness and Disease 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 Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree DK/Ref. Total Agree 71% 64% 68% 73% 55%

27. 27 Supporting Innovation

28. 28 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. Strongly Agree AgreeNeutralDisagreeStrongly Disagree DK/Ref. Public Doctors Nurses Pharmacists Managers Total Agree 81% 83% 86% 82% 81% 88% 85% 84% 80%

29. 29 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 Strongly Agree AgreeNeutralDisagreeStrongly Disagree DK/Ref. Public Doctors Nurses Pharmacists Managers Total Agree 70% 76% 79% 75% 78% 69% 86% 78% 75% 70%

30. 30 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? Strongly Support SupportOpposeStrongly Oppose 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% Total Support

31. 31 Support for Contracting Out Publicly Covered Services: Demographics 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. 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%

33. 33 Paying for Quicker Access: Regional Views 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?

34. 34 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%

35. 35 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 of Services That Are Offered Asking Patients to Pay for Part 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. 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 n/c -3-6 -8 % Strongly/Support

37. 37 Increasing Accountability

38. 38 Making Sure Every Tax Dollar Intended for Health Care is Spent on Health Care 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%

39. 39 Reporting to Canadians the Results of How Those Health Care Dollars are Spent 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% 26%

40. 40 Awareness of Health Council of Canada 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. 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. 42 Conclusions

43. 43 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.

44. 44 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.

45. Health Care in Canada Survey 2004