1. How Canada Compares: Results From The Commonwealth Fund 2014 International Health Policy Survey of Older Adults ReportJanuary 2015

2. Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca copyright@cihi.ca ISBN 978-1-77109-336-1 © 2015 Canadian Institute for Health Information How to cite this document: Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund 2014 International Health Policy Survey of Older Adults. Ottawa, ON: CIHI; 2015. Cette publication est aussi disponible en français sous le titre Résultats du Canada : Enquête internationale de 2014 auprès des adultes âgés sur les politiques de santé du Fonds du Commonwealth. ISBN 978-1-77109-337-8

3. Table of contents Acknowledgements4 About this report5 Executive summary7 Methodological notes12 Access to care 15 Timely access to care16 Cost as a barrier to health care 23 Caregiving and planning for end-of-life care29 Informal caregiving 30 Planning for end of life and advanced age33 Quality of care38 Patient-centred primary and specialist care39 Medication reviews44 Chronic condition management and disease prevention 48 Perception of health and health care55 Appendix60 Bibliography70 3

4. Acknowledgements Core funding for The Commonwealth Fund 2014 International Health Policy Survey of Older Adults was provided by The Commonwealth Fund with co-funding from the following organizations outside of Canada: Haute Autorité de santé (France); Caisse nationale de l’assurance maladie des travailleurs salariés (France); BQS Institute for Quality and Patient Safety (Germany); the German Federal Ministry of Health; the Dutch Ministry of Health, Welfare and Sport; the Scientific Institute for Quality of Healthcare, Radboud University Nijmegen (the Netherlands); the Norwegian Knowledge Centre for the Health Services; the Swedish Ministry of Health and Social Affairs; the Swiss Federal Office of Public Health; the NSW Bureau of Health Information (Australia); and many other country partners. Within Canada, funding for an expanded Canadian sample was provided by the Canadian Institute for Health Information (CIHI), the Canadian Institutes of Health Research (CIHR), the Health Quality Council of Alberta, the Commissaire à la santé et au bien-être du Québec and Health Quality Ontario. Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. 4

5. About this report Health care is fundamentally about people, and the experience of patients is critical to understanding the performance of a health system. For the past decade, The Commonwealth Fund’s International Health Policy surveys have helped fill important information gaps through polls of patients and providers in 11 developed countries. The 2014 edition of this survey focused on the experience of people age 55 and older. The purpose of this companion report is to tell the Canadian story, and to highlight how experiences with health care vary across the country and relative to other countries. For the first time, statistical testing has been performed to understand whether Canadian results are significantly different from the average of 11 Commonwealth Fund (CMWF) surveyed countries. –In bar graphs, an asterisk (*) indicates that Canadian results are statistically different. –Elsewhere in the report where national and provincial results are presented, significance testing is shown with the following colour codes: Additional questions that were asked of only Canadian respondents are indicated throughout this report using a maple leaf. Above averageSame as averageBelow average 5

6. About this report (cont’d) In the body of the report, provincial results are compared with the international average of CMWF countries. In the appendix, provincial results are compared with the Canadian average. Supplementary data tables with expanded questionnaire information are available as a free companion product online.online To provide additional context, this report also references information from CIHI, Statistics Canada and other sources. All other data is from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults. 6

7. Executive summary 7 Canada’s demographic realities are not unique. Understanding how to meet the growing health care needs of an aging population—and how to deliver high-quality care in a cost-efficient fashion—is a challenge that many other nations are trying to address. When comparing the experiences of older people in Canada with those of older people in other countries, this report shows significant variation across the country and mixed results overall.

8. Executive summary (cont’d) 8 Access to care Timely access to primary and specialist care remains a significant challenge for older Canadians. While almost all older Canadians (55 and older) have a regular doctor, 53% waited at least 2 days for care the last time they were sick or needed medical attention, and 25% waited at least 2 months to see a specialist. Canada had the longest waits for primary and specialist care of all 11 countries, and every province had significantly longer waits than the international average. Half of older Canadians found it very or somewhat difficult to get medical care in the evenings and on weekends or holidays without going to the hospital emergency department (ED). Consequently, 37% of individuals responded that the last time they went to the ED, it was for a condition that could have been treated by their regular doctor. While cost was not a barrier to medical services for most older Canadians, a significantly higher proportion (7%) than the average of countries said they were prevented from filling a prescription or skipped a medical dose because of the cost. For 15% of older Canadians, cost was also a barrier for dental care.

9. Executive summary (cont’d) Caregiving and planning for end-of-life care Older Canadians spent more time on average as informal caregivers; they also spent more time planning for their own end-of-life needs. Almost 1 in 5 older Canadians provided care at least once a week to a person with an age-related problem. Nearly half of them (47%) provided care for at least 10 hours a week, a greater proportion than the international average (40%). Nearly 1 in 4 (23%) Canadian caregivers needed help to provide care but did not receive it, and 34% said they had experienced distress, anger or depression while providing care. Older Canadians were significantly more likely than older people in other countries to have discussions (61%) about their end-of life wishes or to have written plans (39%). 9

10. Executive summary (cont’d) Quality of care Generally, older Canadians reported having positive experiences with their providers that were on par with or better than the international average; however, continuity of care between providers can be improved. Older Canadians were more likely on average to be encouraged to ask questions (70%) by their regular doctor and to be involved in treatment plans (79%) by their specialists than older people in other countries. Most older Canadians were taking multiple medications, and they were significantly more likely to report having medication reviews (80%) with their care providers than the international average. Older Canadians with chronic conditions were also more likely to have discussions about treatment goals (60%) and adopting healthy lifestyles (e.g., diet, exercise) with their providers than older people in other countries. However, only 37% had a written plan to self-manage their conditions. A higher proportion of older Canadians (13%) said that specialists did not have basic information or test results from their family doctor. Similarly, 25% said their family doctor did not seem to be informed and up to date about the specialist care they had received. These results varied widely across the country, however. 10

11. Executive summary (cont’d) Perceptions of health and health care While older Canadians were more likely to feel good about their health, they were not as optimistic about their health system. Slightly more than half of older Canadians said their health was very good or excellent, which was significantly higher than the international average. More than half also believed that fundamental changes are required to fix the health system. While perceptions of the health system had improved slightly in the previous 7 years, they were still among the lowest of reporting countries. 11

12. Methodological notes The 2014 Commonwealth Fund International Health Policy Survey of Older Adults randomly sampled the general population age 55 and older in 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. In Canada, interviews were conducted from March through May 2014 by Social Science Research Solutions (SSRS). There were 5,269 respondents. CIHI and CIHR provided funding to ensure a minimum of 250 respondents in each province, allowing for provincial comparisons. Sample sizes were further increased in Quebec, Ontario and Alberta with funding from provincial organizations. The overall response rate in Canada was 28%. For a complete list of sample sizes and response rates from all countries surveyed, please see the accompanying methodology notes.methodology notes 12 Provinces and territories Number of interviews Percentage distribution Newfoundland and Labrador 2525% Prince Edward Island2615% Nova Scotia2585% New Brunswick2775% Quebec1,00619% Ontario1,50229% Manitoba2525% Saskatchewan2545% Alberta95318% British Columbia2505% Yukon30% Northwest Territories10% Nunavut00% Total5,269100%

13. Methodological notes (cont’d) Weighting of results The survey data for Canada was weighted within each of the 10 provinces by age, gender, level of education and knowledge of the official language. Additionally, data was subsequently weighted to reflect Canada’s geographic distribution, by provinces and territories. Population parameters for these calculations were derived from the 2011 Census. Averages and trends For this report, the CMWF average was calculated by adding the results from the 11 countries and dividing by the number of countries. The Canadian average represents the average experience of Canadians (as opposed to the mean of provincial results). Except where otherwise noted, results were compared over time using data from previous CMWF general population surveys for respondents age 55 and older. Significance testing CIHI developed statistical methods to determine whether Canadian results were significantly different from the international average of 11 countries; Provincial results were significantly different from the international average; and Provincial results were significantly different from the Canadian average. An asterisk (*) indicates that results are significantly different on bar graphs, and colour codes are used elsewhere in the report. 13

14. Methodological notes (cont’d) Interpretation of significance testing The following colour codes are used throughout the report to indicate when results are statistically different from the average: Above-average results are more desirable, while below-average results often indicate areas in need of improvement. It must be cautioned, however, that sample sizes in some provinces are much smaller than in others and have wider margins of error. (The most robust samples are in Quebec, Ontario and Alberta because there was additional funding from those provinces.) For this reason, 2 provinces may have the same numeric results in different colours (e.g., 1 result might be blue, or same as average, while the other is orange, or below average). This may be due to a difference in margins of error rather than a difference in health system results. The wider the margin of error, the more difficult it is for a result to show up as significantly different from the average. Above averageSame as averageBelow average 14

15. Access to care Timely access to care Cost as a barrier to health care 15

16. Most older Canadians have a regular doctor of Canadians age 55 and older had 1 or more doctors they usually went to for their medical care. How does Canada compare (2014)? Older Canadians were more likely to have a regular doctor than younger Canadians. 85% of Canadians older than 12 had a regular doctor. Source Statistics Canada. Table 105-0501—Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2013 boundaries) and peer groups, occasional. 96% 16

17. Older Canadians wait longest for primary care No improvement since 2007 Source The Commonwealth Fund, 2007 International Health Policy Survey in Seven Countries. waited for at least 2 days to see a doctor or a nurse the last time they were sick or needed medical attention. 53% How does Canada compare (2014)? 2007 of older Canadians waited at least 6 days or gave up (2014). 30% 53% 17

18. Canadians are least likely to get timely responses Proportion of older Canadians who wished to or were able to email their doctors with a medical question, 2014 Proportion of older Canadians who always or often got an answer the same day when they called their regular doctor with a medical concern In 2012, 11% of family physicians offered patients the option to email them about a medical question or concern. Source The Commonwealth Fund, 2012 Commonwealth Fund International Survey of Primary Care Doctors. 18

19. Canadians have fewer after-hours options for primary care Source The Commonwealth Fund, 2012 Commonwealth Fund International Survey of Primary Care Doctors. thought it was very or somewhat difficult to get medical care in the evenings and on weekends or holidays without going to the emergency department (ED). 51% Proportion of family physicians whose practice had an arrangement for after-hours care How does Canada compare (2014)? 2012 45% 19

20. Lack of access to timely care has an impact on ED use How does Canada compare (2014)? In 2013–2014, 1 in 5 emergency visits in Canada was for a condition that could have been treated elsewhere, such as a doctor’s office. The most common conditions were upper respiratory infections (13%) and antibiotic therapy (13%). Source Canadian Institute for Health Information. Sources of Potentially Avoidable Emergency Department Visits. Ottawa, ON: CIHI; 2014. of older Canadians went to an ED for a condition that could have been treated by their regular doctor. 37% 20

21. Canadians wait longest for specialist care How does Canada compare (2014)?Specialist wait times, by year Sources The Commonwealth Fund, 2010 and 2013 Commonwealth Fund International Health Policy Survey. of older Canadians waited for at least 2 months to see a specialist; these waits had not improved over time. 25% 21

22. How do the provinces compare? Older Canadians (55+) whoB.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Waited for at least 2 days to see a doctor 50%55%57%54%50%58%54%55%53% 32% Said it was very or somewhat difficult to get medical care after hours 47%45%49%55%47%60%53%59%57%65%51%29% Went to the ED for a condition that could have been treated by their regular doctor 30%39%33%34%39%38%42%37%40%50%37%28% Waited for at least 2 months to see their specialist 24%28%32% 24%25%29%27%28%34%25%15% The timeliness of primary and specialist care was significantly below the international average for all Canadian provinces. Compared with the CMWF average Above averageSame as averageBelow average 22

23. In the past yearCanadaCMWF averageUnited States Did not see a doctor for a medical problem because of the cost Skipped a medical test, treatment or follow-up recommended by a doctor because of the cost Did not fill a prescription for medicine or skipped doses of medications because of the cost Did not see a dentist when needed to because of the cost Is cost a barrier to accessing care? 4% In Canada’s publicly funded health care system, most older Canadians accessed the medical care they needed without having to worry about costs. 5%15%5% 15%7%4%15% N/A Compared with the CMWF average Above averageSame as averageBelow averageNot applicable 23

24. Cost can be a barrier for prescription drugs How does Canada compare (2014)?Public share of total prescribed drug spending, 2012 or nearest year Notes * 2008 data. † 2011 data. Source OECD Health Statistics 2014. Did not fill a prescription for medicine or skipped doses because of the cost Canada was second to only the United States in the proportion of older people who did not fill a prescription because of costs. † † † 24

25. Drug costs affect a higher proportion of people age 55 to 65 Proportion by age Canadians age 55 to 64 did not fill their prescriptions or skipped their medications because of the cost. 1 in 10 10% 55–6465+ 5% Most Canadian provinces have public drug coverage programs for seniors age 65+. 25

26. Cost can be a barrier for dental care Only 4 jurisdictions (Alberta, Yukon, the Northwest Territories and Nunavut) have public oral health care services for seniors. Proportion who did not receive dental care by age, 2014 Source Canadian Academy of Health Sciences. Improving Access to Oral Health Care for Vulnerable People Living in Canada. Ottawa, ON: CAHS; 2014. of older Canadians did not receive the dental care they needed because of the cost. 15% 19% 55–64 12% 65+ 26

27. Public coverage of dental care is lower in Canada Share of public spending on outpatient dental care, 2012 or nearest year Source Organisation for Economic Co ‑ operation and Development. Health at a Glance 2013: OECD Indicators. 2013. Probability of a dental visit, by income, 2009 Low incomeHigh income Notes † 2011 data. Source OECD Health Statistics 2014. 47% 79% † † † 27

28. How do the provinces compare? B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Did not see a doctor for a medical problem because of doctor visit costs 4% 3% 4%3%5%3%5%4% 5% Skipped a medical test, treatment or follow-up recommended by a doctor because of diagnostic/ treatment costs 3%4%2%4%7%4%5% 4%6%5% Did not fill a prescription for medicine or skipped doses of medications because of prescription costs 8%6%2%7%8%7%12%7%8%7% 4% Compared with the CMWF average Above averageSame as averageBelow average 28 Results were generally comparable to the international average. Differences in public coverage and program design for drug plans may partly explain variation in results between provinces.

29. Caregiving and planning for end-of-life care Informal caregiving Planning for end of life and advanced age 29

30. Informal caregiving is common across countries Relationship with care receiverProportion providing care for at least 10 hours a week (2014) of older Canadians provided care at least once a week to a person living with an age-related problem (CMWF average 20%). 19% Family member Someone else (not family member) Both 30

31. Informal caregivers in Canada don’t always get the support they need Proportion of caregivers who needed help to provide care in the past year but did not receive it 23% Services were not available in the area Did not know where to go Cost was too expensive Waiting times were too long Reasons for not receiving the help needed to provide care 31

32. experienced distress, anger or depression while providing care or assistance for a family member or friend. 34% Distress is common among Canadian caregivers Proportion of caregivers who experienced distress, anger or depression, by hours of care provision Source Canadian Institute for Health Information. Supporting Informal Caregivers—The Heart of Home Care. Ottawa, ON: CIHI; 2010. Some factors most commonly associated with caregiver distress: Caring for someone with aggressive behaviours Caring for someone with cognition problems (e.g., dementia) Caring for someone for many hours a week 32

33. End-of-life care planning is common in Canada Had discussions with someone Had a written plan about their end-of-life wishes Had a written document naming a substitute decision-maker Proportion of older Canadians who In 2014, older Canadians were more likely than older people in other countries to have planned for their end-of-life wishes. 33

34. End-of-life care plans are more common with advanced age How does Canada compare (2014)?Proportions by age of older Canadians had a written plan about their end-of-life wishes. 39% 34

35. How do the provinces compare? B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Had a discussion with someone 61%62%57%60%64%57%55%56%55%47%61%44% Named a substitute decision-maker 46%53%44%50%60%52%47%43%42%32%53%31% Had a written document about end-of-life wishes 36%43%29%35%44%40%24%29%26%18%39%22% End-of-life care planning in most provinces exceeded the international average. Compared with the CMWF average Above averageSame as averageBelow average 35

36. About half of Canadians are planning for future care needs Proportion who considered supportive living, residential care or home care in future planning Proportion who said they will likely require supportive living or long-term care in their lifetime Compared with the Canadian average Above averageSame as averageBelow average No significant variation by province 53% 36

37. Proportion of Canadian long-term care residents who had Advanced directives are common in long-term care Source Continuing Care Reporting System, 2011, Canadian Institute for Health Information. 37

38. Quality of care Patient-centred primary and specialist care Medication reviews Chronic condition management and disease prevention 38

39. When older Canadians needed care or treatment, their regular doctor always or oftenCanadaCMWF average Knew important information about their medical history Spent enough time with them Encouraged them to ask questions Most older Canadians have a positive experience with their regular doctor 87% 82%86%70%66% Compared with the CMWF average Above averageSame as averageBelow average 39

40. Patient-centred care from specialists is also relatively good in Canada When specialists provided care or treatment, they always or oftenCanadaCMWF average Told patients about treatment choices Involved patients as much as they wanted to be in decisions about treatment or care 72% 79%77% Compared with the CMWF average Above averageSame as averageBelow average 40

41. In the past 2 years, was there a time whenCanadaCMWF average A specialist did not have basic information or test results from the patient’s regular doctor about the reason for the visit A patient’s regular doctor did not seem informed and up to date about the specialist care received However, continuity of care between regular doctors and specialists can be improved 13%9%25%18% Compared with the CMWF average Above averageSame as averageBelow average 41

42. How do the provinces compare? B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Regular doctor always or often Knew important information about patients’ medical history 88%86%89%84%86%89%87%85%87%84%87% Spent enough time with patients 81%80% 79%81%87%80%85%80%78%82%86% Encouraged patients to ask questions 72%70%64%65%68%76%68%66%72%62%70%66% Specialists always or often Told patients about treatment choices 74% 75%78%77%58%73%76%80%77%72% Involved patients as much as they wanted to be in decisions 81%79%83%76%80%76%81%85%88%79% 77% Compared with the CMWF average Above averageSame as averageBelow average 42

43. How do the provinces compare? B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Specialist did not have basic medical information from primary doctor 8% 11%10%26%13%6%4%9%13%9% Primary doctor did not seem informed or up to date about care from specialist 16%18% 46%22%10%13%10%25%18% Continuity of care between primary doctors and specialists was comparable to the international average in most Canadian provinces. Compared with the CMWF average Above averageSame as averageBelow average 43

44. Medication reviews are common for older Canadians How does Canada compare (2014)? Source Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012: Revised October 2014. Ottawa, ON: CIHI; 2014. said a health care professional reviewed their medications in the past 12 months. 80% In Canada, seniors use an average of 7.2 prescription drugs in a year. 44

45. Canadians are more likely to have discussions about medication use In the past 12 months, has a health care professional Provided a written list of all medicationsExplained potential side effects 45

46. Patient safety incidents related to medication use are common in Canada Source Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012: Revised October 2014. Ottawa, ON: CIHI; 2014. Proportion of seniors on public drug programs taking a potentially inappropriate (Beers list) drug, 2012 Source Canadian Institute for Health Information. Adverse Drug Reaction–Related Hospitalizations Among Seniors, 2006 to 2011. Ottawa, ON: CIHI; 2013. Almost 140,000 hospitalizations for adverse drug reactions among seniors between 2006–2007 and 2010–2011 39% 46

47. How do the provinces compare? In the past 12 months, has a health care professional B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Reviewed all medications 77%78% 75%83% 75%66%77%65%80%70% Explained potential side effects 72% 67%76% 67%70%68%62%74%59% Given a written list of all medications 59%58% 51%67%80%66%62%57%54%67%57% Across provinces, medication management among older patients was equal to or better than that in other countries, on average. Compared with the CMWF average Above averageSame as averageBelow average 47

48. Older people with chronic conditions whoCanadaCMWF average Had discussions about main goals or priorities with their health providers Received clear instructions about symptoms to watch for Care to help manage chronic conditions is above average in Canada *Chronic conditions include hypertension or high blood pressure; heart disease, including heart attack; diabetes; asthma or chronic lung disease such as chronic bronchitis, emphysema or chronic obstructive pulmonary disease; depression, anxiety or other mental health problems; cancer; and joint pain or arthritis. of older Canadians had at least 1 chronic condition* (CMWF average 71%). 78% 60%55%60%56% Compared with the CMWF average Above averageSame as averageBelow average 48

49. However, there is room to improve across countries Source The Commonwealth Fund, 2012 Commonwealth Fund International Survey of Primary Care Doctors. CanadaCMWF average People with chronic conditions who received a written plan for self-management from their health provider 37%35% 21% Routinely Occasionally 58% 21% of family physicians routinely gave their patients with chronic conditions written instructions for self-management. 49 Compared with the CMWF average Above averageSame as averageBelow average

50. Hospitalizations for chronic conditions are declining in Canada but vary widely across the country ACSC hospitalization rates (per 100,000) Source Canadian Institute for Health Information. Your Health System. http://yourhealthsystem.cihi.ca/. Accessed November 27, 2014.http://yourhealthsystem.cihi.ca/ Canadian rates Compared with the Canadian average Above averageSame as averageBelow average 50 Ambulatory care sensitive conditions (ACSCs) are chronic conditions that—when treated effectively in community settings—should not, in most cases, lead to hospitalization.

51. How do the provinces compare? B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Discussed with patients their main goals or priorities in caring for this condition 59% 61%57%61% 56%60%61%58%60%55% Given patients clear instructions about symptoms to watch for and when to seek further care or treatment 56%57%60% 58%68%62%58%62%58%60%56% Given patients a written plan to help them manage their own care 42%32%36%34%35%38%35%41%42%39%37%35% In the past 12 months, has a health professional In most provinces, management of chronic conditions was similar to the international average experience. Compared with the CMWF average Above averageSame as averageBelow average 51

52. Discussions about healthy life habits are more frequent in Canada During the past 2 years, has a health professional discussed Source The Commonwealth Fund, 2010 Commonwealth Fund International Health Policy Survey. But they happened less often in 2014 than they used to. 52

53. Canada leads in smoking cessation discussions How does Canada compare (2014)? Source OECD Health Statistics 2014. of older Canadians who smoked said a health professional talked to them about the health risks of smoking or using tobacco and ways to quit. 78% 17% of older Canadians smoked, higher than the CMWF average. Lung cancer mortality rates were among the highest in the world for Canadian women at 46 deaths per 100,000 population. 53

54. How do the provinces compare? B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. A healthy diet and healthy eating 54%52%49%47%52%48% 52% 47%51%43% Exercise or physical activity 60%55%52%51%55% 49%54%55%51%55%48% Things in life that worry patients or cause stress 27%23%25%24%26%20%22%32%22%24%25%23% Health risks of smoking or using tobacco and ways to quit 92%75%66%84%79%71%72% 60%59%78%63% During the past 2 years, has a health professional discussed Compared with the CMWF average Above averageSame as averageBelow average 54

55. Perception of health and health care 55

56. Older Canadians feel better about their health Proportion who rated their health as excellent or very good Proportion who gave the highest rating to the health system But they were not as optimistic about their health system. 56

57. Life expectancy for seniors in Canada is about the same as the international average Life expectancy at age 65, 2011 Canada 18.8 years CMWF average 18.6 years Source OECD Health Statistics 2014. Proportion who rated their health as very good or excellent 52%38% Canada 21.7 years CMWF average 21.6 years CMWF averageCanada 57 Life expectancy is a different way of measuring the health of a population. Compared with the CMWF average Above averageSame as averageBelow average

58. Overall view of the health care system, 2007 and 2014 Perceptions of health systems are still low in Canada but have improved slightly On the whole, the system works well and only minor changes are necessary to make it work better. There are some good things in our health care system, but fundamental changes are needed to make it work better. Our health care system has so much wrong with it that we need to completely rebuild it. 20072014 54% 27% 16% 34% 53% 10% 58

59. How do the provinces compare? Health system perceptions by province B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Minor changes 40%35%33%34%39%22%36%34%33%23%34%44% Fundamental changes 51% 52%49%48%63%51%53% 52%53%42% Completely rebuilt 6%9%10% 9%12%11%9%8%21%10% Self-reported health status by province B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can.CMWF Avg. Excellent or very good 52%56%44%48%52%53%44%42%44%56%52%38% Compared with the CMWF average Above averageSame as averageBelow average 59

60. Appendix Provincial results compared to the Canadian average Statistical testing indicates whether results are significantly different from the Canadian average. 60

61. Timely access to primary care Older Canadians (55+) whoB.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Waited for at least 2 days to see a doctor 50%55%57%54%50%58%54%55%53% Said it was very or somewhat difficult to get medical care after hours 47%45%49%55%47%60%53%59%57%65%51% Went to the ED for a condition that could have been treated by their regular doctor 30%39%33%34%39%38%42%37%40%50%37% Waited for at least 2 months to see their specialist 24%28%32% 24%25%29%27%28%34%25% Compared with the Canadian average Above averageSame as averageBelow average 61

62. Cost as a barrier to health care B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Did not see a doctor for a medical problem because of doctor visit costs 4% 3% 4%3%5%3%5%4% Skipped a medical test, treatment or follow-up recommended by a doctor because of diagnostic/treatment costs 3%4%2%4%7%4%5% 4%6%5% Did not fill a prescription for medicine or skipped doses of medications because of prescription costs 8%6%2%7%8%7%12%7%8%7% Did not see a dentist when needed to because of the dental costs 17%12%9%15%16%14%19%18%11%16%15% Compared with the Canadian average Above averageSame as averageBelow average 62

63. Quality of care: patient-centred care B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Regular doctor always or often Knew important information about patients’ medical history 88%86%89%84%86%89%87%85%87%84%87% Spent enough time with patients 81%80% 79%81%87%80%85%80%78%82% Encouraged patients to ask questions 72%70%64%65%68%76%68%66%72%62%70% Specialists always or often Told patients about treatment choices 74% 75%78%77%58%73%76%80%77%72% Involved patients as much as they wanted to be in decisions 81%79%83%76%80%76%81%85%88%79% Compared with the Canadian average Above averageSame as averageBelow average 63

64. Quality of care: continuity of primary and specialist care B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Specialist did not have basic medical information from primary doctor 8% 11%10%26%13%6%4%9%13% Primary doctor did not seem informed or up to date about care from specialist 16%18% 46%22%10%13%10%25% Compared with the Canadian average Above averageSame as averageBelow average 64

65. Quality of care: medication reviews In the past 12 months, has a health care professional B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Reviewed all medications 77%78% 75%83% 75%66%77%65%80% Explained potential side effects 72% 67%76% 67%70%68%62%74% Given a written list of all medications 59%58% 51%67%80%66%62%57%54%67% Compared with the Canadian average Above averageSame as averageBelow average 65

66. Quality of care: management of chronic conditions B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Discussed with patients their main goals or priorities in caring for this condition 59% 61%57%61% 56%60%61%58%60% Given patients clear instructions about symptoms to watch for and when to seek further care or treatment 56%57%60% 58%68%62%58%62%58%60% Given patients a written plan to help them manage their own care 42%32%36%34%35%38%35%41%42%39%37% In the past 12 months, has a health professional Compared with the Canadian average Above averageSame as averageBelow average 66

67. Quality of care: health promotion B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. A healthy diet and healthy eating 54%52%49%47%52%48% 52% 47%51% Exercise or physical activity 60%55%52%51%55% 49%54%55%51%55% Things in life that worry patients or cause stress 27%23%25%24%26%20%22%32%22%24%25% Health risks of smoking or using tobacco and ways to quit 92%75%66%84%79%71%72% 60%59%78% During the past 2 years, has a health professional discussed Compared with the Canadian average Above averageSame as averageBelow average 67

68. End-of-life care B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Had a discussion with someone 61%62%57%60%64%57%55%56%55%47%61% Named a substitute decision-maker 46%53%44%50%60%52%47%43%42%32%53% Had a written document about end-of-life wishes 36%43%29%35%44%40%24%29%26%18%39% Compared with the Canadian average Above averageSame as averageBelow average 68

69. Perception of health and health care Health system ratings by province B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Minor changes 40%35%33%34%39%22%36%34%33%23%34% Fundamental changes 51% 52%49%48%63%51%53% 52%53% Completely rebuilt 6%9%10% 9%12%11%9%8%21%10% Self-reported health status by province B.C.Alta.Sask.Man.Ont.Que.N.B.N.S.P.E.I.N.L.Can. Excellent or very good 52%56%44%48%52%53%44%42%44%56%52% Compared with the Canadian average Above averageSame as averageBelow average 69

70. Bibliography Canadian Academy of Health Sciences. Improving Access to Oral Health Care for Vulnerable People Living in Canada. Ottawa, ON: CAHS; 2014. http://www.cahs-acss.ca/wp-content/uploads/2014/09/ Access_to_Oral_Care_FINAL_REPORT_EN.pdf. Accessed on November 27, 2014.http://www.cahs-acss.ca/wp-content/uploads/2014/09/ Access_to_Oral_Care_FINAL_REPORT_EN.pdf Canadian Institute for Health Information. Adverse Drug Reaction–Related Hospitalizations Among Seniors, 2006 to 2011. Ottawa, ON: CIHI; 2013. https://secure.cihi.ca/free_products/ Hospitalizations%20for%20ADR-ENweb.pdf. Accessed November 27, 2014.https://secure.cihi.ca/free_products/ Hospitalizations%20for%20ADR-ENweb.pdf Canadian Institute for Health Information. Continuing Care Reporting System. Ottawa, ON: CIHI; 2011. Canadian Institute for Health Information. Drug Use Among Seniors on Public Drug Programs in Canada, 2012: Revised October 2014. Ottawa, ON: CIHI; 2014. https://secure.cihi.ca/free_products/ Drug_Use_in_Seniors_on_Public_Drug_Programs_EN_web_Oct.pdf. Accessed November 27, 2014.https://secure.cihi.ca/free_products/ Drug_Use_in_Seniors_on_Public_Drug_Programs_EN_web_Oct.pdf Canadian Institute for Health Information. Sources of Potentially Avoidable Emergency Department Visits. Ottawa, ON: CIHI; 2014. https://secure.cihi.ca/free_products/ED_Report_ ForWeb_EN_Final.pdf. Accessed November 27, 2014.https://secure.cihi.ca/free_products/ED_Report_ ForWeb_EN_Final.pdf Canadian Institute for Health Information. Supporting Informal Caregivers—The Heart of Home Care. Ottawa, ON: CIHI; 2010. https://secure.cihi.ca/free_products/Caregiver_Distress_AIB_2010_EN.pdf. Accessed November 27, 2014.https://secure.cihi.ca/free_products/Caregiver_Distress_AIB_2010_EN.pdf Canadian Institute for Health Information. Your Health System. http://yourhealthsystem.cihi.ca/. Accessed November 27, 2014.http://yourhealthsystem.cihi.ca/ 70

71. Bibliography (cont’d) The Commonwealth Fund. 2007 International Health Policy Survey in Seven Countries. New York, U.S.: CMWF; 2007. http://www.commonwealthfund.org/~/media/files/surveys/2007/2007- international-health-policy-survey-in-seven-countries/schoen_intlhltpolicysurvey2007_chartpack- pdf.pdf. Accessed November 27, 2014.http://www.commonwealthfund.org/~/media/files/surveys/2007/2007- international-health-policy-survey-in-seven-countries/schoen_intlhltpolicysurvey2007_chartpack- pdf.pdf The Commonwealth Fund. The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries. New York, U.S.: CMWF; 2010. http://www.commonwealthfund.org/~/media/files/ publications/chartbook/2010/pdf_2010_ihp_survey_chartpack_full_12022010.pdf. Accessed November 27, 2014.http://www.commonwealthfund.org/~/media/files/ publications/chartbook/2010/pdf_2010_ihp_survey_chartpack_full_12022010.pdf The Commonwealth Fund. 2012 Commonwealth Fund International Survey of Primary Care Doctors. New York, U.S.: CMWF; 2012. http://www.commonwealthfund.org/~/media/files/publications/in-the- literature/2012/nov/ppt_2012_ihp_survey_chartpack.pptx. Accessed November 27, 2014. http://www.commonwealthfund.org/~/media/files/publications/in-the- literature/2012/nov/ppt_2012_ihp_survey_chartpack.pptx The Commonwealth Fund. 2013 Commonwealth Fund International Health Policy Survey. New York, U.S.: CMWF; 2013. http://www.commonwealthfund.org/~/media/files/publications/in-the- literature/2013/nov/ppt_oecd_multinational_comparisons_hlt_sys_data_2013.pptx. Accessed November 27, 2014. http://www.commonwealthfund.org/~/media/files/publications/in-the- literature/2013/nov/ppt_oecd_multinational_comparisons_hlt_sys_data_2013.pptx Organisation for Economic Co-operation and Development. Health at a Glance 2013: OECD Indicators. Paris, France: OECD; 2013. 71

72. Bibliography (cont’d) Organisation for Economic Co-operation and Development. OECD Health Statistics, 2014. Paris, France: OECD; 2014. Statistics Canada. Table 105-0501—Health indicator profile, annual estimates, by age group and sex, Canada, provinces, territories, health regions (2013 boundaries) and peer groups, occasional. CANSIM (database). http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1050501. Updated June 11, 2014. Accessed November 27, 2014.http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=1050501 72