1. HEALTH CARE IN CANADA SURVEY Retrospective ÉTUDE SUR LES SOINS DE SANTÉ AU CANADA Rétrospective 1998 – 2004 May 2004 http://www.hcic-sssc.ca HEALTH CARE IN CANADA SURVEY Retrospective ÉTUDE SUR LES SOINS DE SANTÉ AU CANADA Rétrospective 1998 – 2004 May 2004 http://www.hcic-sssc.ca

2. 2 Introduction  HCIC is a comprehensive annual survey developed in partnership by key stakeholders in the health system.  The HCIC partnership has conducted six extensive studies from 1998 to 2003.  In the fall of 2003, a Retrospective Review of all results was completed.  Today we are presenting those retrospective results supplemented with the results of a few survey questions to the public (conducted in April of 2004).  HCIC is a comprehensive annual survey developed in partnership by key stakeholders in the health system.  The HCIC partnership has conducted six extensive studies from 1998 to 2003.  In the fall of 2003, a Retrospective Review of all results was completed.  Today we are presenting those retrospective results supplemented with the results of a few survey questions to the public (conducted in April of 2004).

3. 3 HCIC Partners  Association of Canadian Academic Healthcare Organizations  Canadian Association for Community Care  Canadian College of Healthcare Executives  Canadian Healthcare Association  Canadian Homecare Association  Canadian Medical Association  Canadian Nursing Association  Canadian Pharmacists Association  Coalition of National Voluntary Associations  Merck Frosst Canada Ltd.  POLLARA Research  Rogers Media  Association of Canadian Academic Healthcare Organizations  Canadian Association for Community Care  Canadian College of Healthcare Executives  Canadian Healthcare Association  Canadian Homecare Association  Canadian Medical Association  Canadian Nursing Association  Canadian Pharmacists Association  Coalition of National Voluntary Associations  Merck Frosst Canada Ltd.  POLLARA Research  Rogers Media

4. 4 Methodology  Each year, 1,200 Canadians interviewed “on the issue of health care”.  Canadians were interviewed by telephone using Computer Assisted Telephone Interviewing (CATI).  Overall results for the public are considered accurate within +/- 2.9% nineteen times out of twenty.  Each year, 1,200 Canadians interviewed “on the issue of health care”.  Canadians were interviewed by telephone using Computer Assisted Telephone Interviewing (CATI).  Overall results for the public are considered accurate within +/- 2.9% nineteen times out of twenty.

5. 5 Most Important Issue Facing Canada: Tracking Question:In your opinion, what is the single most important issue facing Canada today? Sponsorship/ 11% Politicians 1% Environment 3% Taxes 4% Unempl 19% Health 9% Deficit Economy 7% From 2000 onwards healthcare has been rated as the most important issue facing Canada

6. 6 Areas of Social Investment Question:I’d like to read to you a list of areas in which the federal government currently spends your taxes. For each one, please tell me whether you believe the government should spend more, spend the same, or spend less of your tax dollars in that area. How about: (READ AND ROTATE) 82% 72% 55% 48% 24% 20% -13%

7. 7 Most important issues ‘98‘99‘00‘01‘02’03 %%% Lack of Funding/Govt Cutbacks18919121514 Long Waiting Period46710911 Lack of Staff/Overload241013810 Accessibility/Availability534688 Aging Population/Elderly555536 Cost of Health Care323344 Funding, waiting lists and staffing consistently cited most important issues

8. 8 Quality of Care Question: 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)... Quality of care provided to patients. 2000 2001 2002 2003 Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied DK/ Ref.

9. 9 Percentage Receiving Quality Health Care Now 1998 1999 2000 2001 2002 2003 Question:Overall would you say that Canadians are or are not receiving quality health care right now?

10. 10 Satisfaction with Range and Comprehensiveness Question: 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)... The range, or comprehensiveness, of care and services covered under government funded health care. 2000 2001 2002 2003 Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied DK/ Ref.

11. 11 Satisfaction with Access in Community Question: 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)... Access to care in the home or community. 2000 2001 2002 2003 Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied DK/ Ref.

12. 12 Quality in the health system  Tracking results show consistently between 2000 and 2003 About 70% of Canadians say they are satisfied with the quality of care in the health system. About 60% of Canadians feel that Canadians are receiving quality care. About 60% are satisfied with range and comprehensiveness of services About 45% satisfied with access to care in the home and community  Question: What satisfaction levels should we expect for our health care programs?  Tracking results show consistently between 2000 and 2003 About 70% of Canadians say they are satisfied with the quality of care in the health system. About 60% of Canadians feel that Canadians are receiving quality care. About 60% are satisfied with range and comprehensiveness of services About 45% satisfied with access to care in the home and community  Question: What satisfaction levels should we expect for our health care programs?

13. 13 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)(2003) General Public Thinks Key concern is supply of physicians and nurses

14. 14 Attitudes & Priorities for Investment  When asked about priorities for new health care investments Canadians generally focus on access to acute and specialized services as a priority: Access to emergency care (a top priority for 55%, 2003). Access to specialists and surgeons (a top priority for 50%, 2003); and, Timeliness of access to care (49% a top priority, 2003).  It would appear that a recent emphasis by politicians on improving timely access to emergency and surgical services does reflect public priorities.  To support those priorities the public has been supportive of increased funding for healthcare (particularly an increase in federal share of funding).  When asked about priorities for new health care investments Canadians generally focus on access to acute and specialized services as a priority: Access to emergency care (a top priority for 55%, 2003). Access to specialists and surgeons (a top priority for 50%, 2003); and, Timeliness of access to care (49% a top priority, 2003).  It would appear that a recent emphasis by politicians on improving timely access to emergency and surgical services does reflect public priorities.  To support those priorities the public has been supportive of increased funding for healthcare (particularly an increase in federal share of funding).

15. 15 Innovative Solutions & Incentives  Besides increased funding the public is also supportive of a wide number of options to reform the system. Some examples from past surveys include: creating an additional public insurance program to cover what is not funded in the public system (61% support in 2001); contracting out delivery of publicly funded services to private clinics (57% support in 2003); providing tax breaks to those who do not use many health care services (55% in 2002).  The public is often more receptive to new reforms than politicians or providers.  Besides increased funding the public is also supportive of a wide number of options to reform the system. Some examples from past surveys include: creating an additional public insurance program to cover what is not funded in the public system (61% support in 2001); contracting out delivery of publicly funded services to private clinics (57% support in 2003); providing tax breaks to those who do not use many health care services (55% in 2002).  The public is often more receptive to new reforms than politicians or providers.

16. 16 Collaborative Care  Of key interest to HCIC partners was Canadian support for primary care reform - 70% of Canadians support the idea of collaborative care. Collaborative Care: “a team including a doctor, nurse, pharmacist, or other health care provider who would collectively provide care” (2003 data). Most popular in Quebec: 85% support;  Canadians feel that this model will improve the quality of patient care (73%) and improve the speed of access to care (69%).  There are some barriers to implementation but public resistance is not one of them: Providers: think “poor planning by government” Managers: think “resistance by providers”  Of key interest to HCIC partners was Canadian support for primary care reform - 70% of Canadians support the idea of collaborative care. Collaborative Care: “a team including a doctor, nurse, pharmacist, or other health care provider who would collectively provide care” (2003 data). Most popular in Quebec: 85% support;  Canadians feel that this model will improve the quality of patient care (73%) and improve the speed of access to care (69%).  There are some barriers to implementation but public resistance is not one of them: Providers: think “poor planning by government” Managers: think “resistance by providers”

17. 17 Support for Specific Components of Collaborative Care  Canadians are supportive of measures to ensure that collaborative care takes place.  This includes support for: requiring patients to register with one family doctor (74% support this policy); receiving personal health care statements outlining the cost of health care (70% support); and, allowing the sharing of personal health information amongst member of the collaborative teams of providers (66%).  So, Canadians are in favor of addressing sustainability of the health system by: increasing funding and by changing how we do things.  What about reducing what the health system offers…  Canadians are supportive of measures to ensure that collaborative care takes place.  This includes support for: requiring patients to register with one family doctor (74% support this policy); receiving personal health care statements outlining the cost of health care (70% support); and, allowing the sharing of personal health information amongst member of the collaborative teams of providers (66%).  So, Canadians are in favor of addressing sustainability of the health system by: increasing funding and by changing how we do things.  What about reducing what the health system offers…

18. 18 Opposition to Restricting Benefits  There has been staunch opposition to the idea of rationing or restricting services…which has grown stronger over the last couple of years. 76% oppose restricting the range of services to manage health care costs (2003). This was particularly strong in Atlantic Canada, (87% opposed). 90% strongly agree that all services proven to improve health and quality of life should be government funded (2001)  With the public not wanting to reduce the range of benefits - governments are clearly facing some challenges to ensure a sustainable system.  We need to change how we do things.  There has been staunch opposition to the idea of rationing or restricting services…which has grown stronger over the last couple of years. 76% oppose restricting the range of services to manage health care costs (2003). This was particularly strong in Atlantic Canada, (87% opposed). 90% strongly agree that all services proven to improve health and quality of life should be government funded (2001)  With the public not wanting to reduce the range of benefits - governments are clearly facing some challenges to ensure a sustainable system.  We need to change how we do things.

19. 19 Support for Research and Innovation  There is strong support for increased government funding for health care research (83% overall support in 2003);  There is also strong support for government to put incentives in place to increase private sector funding for health research (76% in 2003);  The public supports the development and availability of new technologies.  They oppose limiting the introduction of new health technology as an option to control spending (67% oppose this approach in 2000).  There is strong support for access to the full range of newest services and benefits even if this means partial personal payment.  There is strong support for increased government funding for health care research (83% overall support in 2003);  There is also strong support for government to put incentives in place to increase private sector funding for health research (76% in 2003);  The public supports the development and availability of new technologies.  They oppose limiting the introduction of new health technology as an option to control spending (67% oppose this approach in 2000).  There is strong support for access to the full range of newest services and benefits even if this means partial personal payment.

20. 20 Who should lead reforms Who is trusted to lead health reforms?  More than two thirds of Canadians are dissatisfied with government accountability in health care spending.  Canadians want innovation in the health care system - such innovation will require leadership.  However fewer than half believe the federal and provincial governments are providing the necessary leadership.  They are more positive to leadership coming from patient groups, those who work directly in the system, and private companies that develop new technology and medicines.  The leadership for the future will require increased accountability to the public and an increased voice for patients. Who is trusted to lead health reforms?  More than two thirds of Canadians are dissatisfied with government accountability in health care spending.  Canadians want innovation in the health care system - such innovation will require leadership.  However fewer than half believe the federal and provincial governments are providing the necessary leadership.  They are more positive to leadership coming from patient groups, those who work directly in the system, and private companies that develop new technology and medicines.  The leadership for the future will require increased accountability to the public and an increased voice for patients.

21. 21 Accountability & Level of Reporting 47% satisfaction with level of public reporting on quality of health system Question: 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)... The level of reporting to the public on health system performance. 2000 2001 2002 2003 Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied DK/ Ref.

22. 22 Satisfaction with Amount of Public Input 60-65% of Canadians dissatisfied with levels of input Question: 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)... How much input the public has on decisions about the future of the health system? 2000 2001 2002 2003 Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied DK/ Ref.

23. 23 Snapshot: Spring of 2004  The HCIC partners decided to ask some of our key tracking questions to accompany this retrospective. Confidence Expectations of Improvement Approach to Reform Timeliness of Access to Care Willingness to Pay  The HCIC partners decided to ask some of our key tracking questions to accompany this retrospective. Confidence Expectations of Improvement Approach to Reform Timeliness of Access to Care Willingness to Pay

24. 24 Confidence in the Health Care System Question: 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 2004 Confidence in the system has remained about the same: 49% of Canadians with falling confidence in the system

25. 25 Canadians more pessimistic about improvements in access to care Question: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 2004 Significantly Improve Improve Somewhat Worsen Somewhat Significantly Worsen DK/Ref. A majority of Canadians expect access to worsen over the next 5 years 52% (up from 44% in 2003)

26. 26 Approach for System Reform Question: 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 Complete Rebuilding Fairly Major Repairs Minor Tuning Up Everything's Fine 64% of Canadians feel system needs a complete rebuilding or major repairs

27. 27 Timeliness of Access to Care Question: 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 2004 Very Satisfied Somewhat Satisfied Somewhat Dissatisfied Very Dissatisfied DK/ Ref. 51% of Canadians dissatisfied with timeliness of access to care

28. 28 Canadians willing to pay 54% of Canadians willing to pay more for improved timeliness, scope of services or both (down from 60% in 2003, 69% in 2002)) Question: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? Source: Health Care In Canada survey: POLLARA Research 2002 2003 2004 YES - Range of Services YES - Improve Timeliness YES – Both NO – Neither DK/ Ref.

29. 29 Conclusion  Public confidence in the health system remains about the same (split 50/50). Only 5%-6% have rising confidence.  Expectations for improvements over the next five years have dropped.  Majority of those surveyed are still willing to pay (to improve timeliness, range of services, or both) but that majority has dropped from 60% to 54%.  A majority of Canadians (65%) feel the system needs a complete rebuilding or major repairs.  They want Access and they want Innovation.  Public confidence in the health system remains about the same (split 50/50). Only 5%-6% have rising confidence.  Expectations for improvements over the next five years have dropped.  Majority of those surveyed are still willing to pay (to improve timeliness, range of services, or both) but that majority has dropped from 60% to 54%.  A majority of Canadians (65%) feel the system needs a complete rebuilding or major repairs.  They want Access and they want Innovation.

30. 30 Conclusion  The HCIC partnership wants to move beyond annual surveys to include the promotion of an interactive dialogue on these important issues.  The HCIC partnership plans to conduct a larger survey in the late summer/early fall prior to holding a roundtable on Ensuring Access and Innovation in Canadian Health System and provide some guidance to the new Health Council.  The HCIC partnership wants to move beyond annual surveys to include the promotion of an interactive dialogue on these important issues.  The HCIC partnership plans to conduct a larger survey in the late summer/early fall prior to holding a roundtable on Ensuring Access and Innovation in Canadian Health System and provide some guidance to the new Health Council.