Canadians’ Thoughts on
Their Health Care System:
Preserving the Canadian
Model Through Innovation
by
Matthew Mendelsohn
Queen’s University
June 2002
The findings of this paper are the sole responsibility of the author and, as such,
have not been endorsed by the Commission.
Many of the polling data reported in this paper have been generously made
available to the Commission by Canada’s leading public opinion research firms.
Many are proprietary and copyrighted. They should not be reproduced without
permission of the firm.
Contents
List of Figures
iv
Executive Summary
vii
Introduction
Summary
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I
Background: Growing Concerns about Health Care
Summary
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II
Canadians’ Evolving Values in Regard to Health Care
Canadians’ New Values
Acting on Values
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III
Sustainability
Support for the Canadian Health Care Model but Growing Concerns
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IV
Proposed Improvements
More Privatization?
User Fees?
Home Care and Pharmacare?
Primary Care Health Service Teams?
The Future of Hospitals?
Extending Life?
A “Wellness Agenda”?
Tough Choices
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V
Accountability
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VI
The Federal Context and the Role of Government
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VII Different Canadians, Different Views?
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VIII The Path Forward – What Are Canadians Saying?
21
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List of Figures
Figure 1: Support for Canadian Health Care System Model
Figure 2: Support for Universality
Figure 3: Evolution of Assessments of the Quality of the Health Care System
Figure 4: Is the American System Better?
Figure 5: Preference for Care in Canada Rather than the U.S.
Figure 6: Health Care and National Identity
Figure 7: Health Care Should be Guaranteed by the Government
Figure 8: Support for the Canadian Health Care Model
Figure 9: Five Year Trend on Perceptions of Quality
Figure 10: Options for Reform
Figure 11: Future Directions for the Health Care System
Figure 12: Is More Money Alone the Answer?
Figure 13: Knowledge of the Canada Health Act
Figure 14: Canadians’ Highest Priorities
Figure 15: Images of the Future of Health Care
Figure 16: Is Progress Being Made?
Figure 17: A Funding Crisis?
Figure 18: Satisfied with Medicare?
Figure 19: System in Crisis? International Comparisons
Figure 20: Federal/Provincial Satisfaction
Figure 21: Government Performance on Health Care 1988-99
Figure 22: Who Is Responsible for Deterioration?
Figure 23: Quality of Care: 2000-01
Figure 24: Personal Experiences with the System
Figure 25: Confidence in Health Care Services
Figure 26: Inability to Access Health Care: 1989-2001
Figure 27: Inability to Access Health Care by Province: 1989-2000
Figure 28: Satisfaction with Care: Own Family versus Province
Figure 29: Difficulty Obtaining Health Care: 1989-2000
Figure 30: Difficulties in Seeing Specialists: International Comparisons
Figure 31: Concerns about Waiting Times
Figure 32: System Performance
Figure 33: Support for Equalization
Figure 34: Growing Empowerment
Figure 35: Use of Health Related Internet Sites
Figure 36: Discussions with Physicians Regarding Internet Information
Figure 37: Communication with Physicians by E-mail and Internet
Figure 38: Use of E-mail and Internet: Sociodemographic Differences
Figure 39: Health Related Purchases over the Internet
Figure 40: Use of Natural Health Products
Figure 41: Use of Alternative Health Providers
Figure 42: Use of Natural Health Products by Region
Figure 43: Health Information on the Internet
Figure 44: Use of the Internet: Which Sites?
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Figure 45: Support for the Principles of the Canada Health Act: 1991-99
Figure 46: Entirely Public or Some Private?
Figure 47: Support for Some Private Care: 2000-2001
Figure 48: Opposition to Funding Cuts
Figure 49: Coverage of Public Health Care
Figure 50: Restore Funding or New Programs: 1996
Figure 51: Quality vs. Equal Access
Figure 52: Equal Access vs. Quality of Care
Figure 53: Where Should the Money Come From? (Saskatchewan)
Figure 54: Where Should the Money Come From? (National)
Figure 55: Tracking Privatization
Figure 56: Opposition to Privatization
Figure 57: Opposition to a Mixed Public/Private System
Figure 58: Some Support for Two-Tiered?
Figure 59: Paying for Quicker Access? 1996-2001
Figure 60: Paying for Quicker Access? Regional Breakdown
Figure 61: Paying for Quicker Care?
Figure 62: Paying to Get to the Head of the Line?
Figure 63: Perception of Treatment in Private System
Figure 64: Paying for Timely Access?
Figure 65: Attitudes toward “Bill 11” Model
Figure 66: Attitudes toward Bill 11
Figure 67: Arguments in Opposition to Bill 11
Figure 68: Arguments in Opposition to Bill 11 #2
Figure 69: Arguments in Support of Bill 11
Figure 70: Arguments in Support of Bill 11 #2
Figure 71: Arguments in Opposition to Privatization
Figure 72: Arguments in Support of Privatization
Figure 73: User Fees
Figure 74: Options for Raising Funds
Figure 75: Deep Support for User Fees?
Figure 76: How Good an Idea Is Each of the Following?
Figure 77: Canadians Giving Informal Care
Figure 78: The Financial Burden of Informal Care
Figure 79: General Support for Pharmacare
Figure 80: Pharmacare: What Drugs to Include?
Figure 81: Support for Primary Health Service Teams
Figure 82: Doctors or Specialized Professionals?
Figure 83: Support for Team Practices
Figure 84: Importance of Keeping Hospitals Open
Figure 85: Hospitals or Community Care?
Figure 86: Options for Hospital Restructuring
Figure 87: How Important Should Each of the
Following Goals Be for the Health Care System?
Figure 88: Physician Assisted Suicide
Figure 89: Treating Disease or Promoting Health?
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Figure 90: Short-Term Policy Options
Figure 91: Importance of Various Goals
Figure 92: Preferences for Spending
Figure 93: Causes of Inefficiency
Figure 94: Causes of Inefficiency: Do Doctors Abuse the System?
Figure 95: Causes of Inefficiency: Do Patients Abuse the System?
Figure 96: Two Views on Ensuring Quality
Figure 97: Two Views on New Drugs and Procedures
Figure 98: Willingness to Try Experimental Therapies
Figure 99: Hours of Hospital Emergency Use
Figure 100: Alternatives to Hospital Emergency Service
Figure 101: Support for Community Report Cards
Figure 102: Focus of Community Report Cards
Figure 103:Importance of Community Report Cards
Figure 104: Role of the Federal Government
Figure 105: Support for National Pharmacare
Figure 106: Federal Role
Figure 107: Federal Contribution to Health Care
Figure 108: Under Whose Authority?
Figure 109: Who Should Take the Lead?
Figure 110: Who Should Lead?
Figure 111: Who Is to Blame?
Figure 112: The Importance of National Standards
Figure 113: Who Should Set National Standards?
Figure 114: Enforcement of the Canada Health Act
Figure 115: Regional Variations on Withholding Money
Figure 116: Who Should Be Involved in Policy?
Figure 117: Spending on Social Programmes: Socioeconomic Differences
Figure 118: Quality and Access Trade-off: Socioeconomic Differences
Figure 119: Support for Pharmacare: Sociodemographic Differences
Figure 120: Regional Variations on Privatization Models?
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Executive Summary
This paper examines the evolution of Canadian public opinion on the health care system
during the past twenty years. Specific attention is paid to the state of opinion since 1996.
The author reviews and summarizes all publicly available polling data.
Canadians speak very clearly through the polls on a number of issues. First,
Canadians are very attached and proud of their health care system. Second, they are very
supportive of the principles of the Canada Health Act and what they understand to be the
core elements of medicare, namely that the system is national and publicly-funded, and
that it provides to Canadians universal coverage and medical care on the basis of need.
Third, Canadians have perceived a marked deterioration in the quality of the system
during the past decade, particularly in regards to waiting times for specialists, waiting
times at emergency rooms, the availability of the best technology, and adequate numbers
of doctors and nurses. Consequently, Canadians have become very worried about the
future of the health care system.
Canadians have reached a mature, settled public judgment, based on decades of
experience, that the Canadian health care model is a good one that should be preserved.
This public judgment is reflected in the fact that the overwhelming response to perceived
deterioration has not been to reconsider the model, but to call for governments to fix the
system through better collaboration and management, the injection of more funds, and
small modifications. Canadians are aware of the challenges faced by the system and are
increasingly open to some experimental modifications, but policy debate on potential
changes must be predicated on the presumption that Canadians like the Canadian health
care model, have an attachment to the present system, and would like improvements
designed to reinforce the system with which they are familiar, not undermine it through
radical change. In regards to proposed reforms, Canadians prefer those changes that
support the basic model and principles.
Canadians believe that access to medical care should be guaranteed by
government, and recent surveys have shown that 91% believe that care should be based
on need, 72% believe that Medicare embodies Canadian values, and only 8% believe that
the American system is better than the Canadian. The attachment Canadians have to their
health care system is not only symbolic: to the extent that they know about other systems,
they prefer the Canadian.
Canadians are worried about the system’s future and do not believe that all is
well. Only 37% of Canadians agree with the statement that Medicare is just fine the way
it is, a remarkably low percentage considering the great attachment that Canadians have
to the system. In 1989, only 2% of Canadians said they had not been able to get the
medical care they needed, while this jumped to 15% in 2001. Most Canadians (88%)
believe there is a funding crisis or will be in the short-term, but most do not believe that
the system can be fixed simply through the injection of more funds.
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Only about 1/3 of Canadians say they support “two-tiered” or “privatization”
models, with most Canadians strongly opposed to these proposals. The strong opposition
to “two-tiered” health is in tension with Canadians’ belief that individuals should be able
to use their money as they see fit to protect their own health. Canadians are sensitive to
the desire amongst many Canadians to spend their own money if they are facing a
lengthy wait for treatment. While there is strong opposition in Canada to people being
able to pay to go to the front of the line for procedures, when Canadians are faced with
the proposition: “should Canadians be allowed to have the option of using private
facilities with their own resources if they cannot get timely access in the public system,”
73% say so. This is a crucial value tension: Canadians want to nurture the public system,
but they fully sympathize with someone who wants to spend their own money to get the
care they need.
The perceived deterioration within the system has made Canadians more open to a
variety of options than they were a decade ago, provided that the core elements of the
system are preserved and that these reforms lead to real and tangible improvements in
quality without damaging accessibility. Canadians are aware of inefficiencies in the
system, and aware of some of the incentives built into the system that perpetuate these
inefficiencies and damage accountability. Most appear prepared to entertain reforms to
the organization of primary health care. Any re-organization of primary care would
attract more support amongst Canadians if it improved efficiency and accountability and
eliminated waste and unnecessary procedures, all key preoccupations of Canadians.
Reforms might also include the ability to “buy extras” or be insured for “extras” within
the context of the core public system. Nonetheless, this report suggests very strong
support for the public system, a willingness to pay to ensure quality, and a discomfort
with either privatization or curtailing access to services, although support for some
privatization experiments has gone up in recent years as Canadians struggle to find ways
to maintain quality and access without large increases in taxes (only about 1 Canadian in
3 supports tax increases to fund improvements to the system).
Quality and accessibility are the key principles for Canadians, but polling
questions related to the trade-off between access and quality are very difficult to interpret
because just about all Canadians are deeply committed to both and most Canadians have
not really thought about how to strike a balance between the two principles. Most older or
low income Canadians instinctively choose “access” because many sense that they would
be negatively affected by a system that did not guarantee equal access for all, while many
wealthier Canadians choose “quality” because they are increasingly concerned that the
best available procedures and technology are not being used because of cost
considerations. Nonetheless, the two clear messages emerging from many polls are that
Canadians have become increasingly concerned about the quality of care provided by the
health care system, and that quality and access can be understood as the two key
principles of the health care system to which most Canadians are deeply attached.
Canadians strongly believe that the federal, provincial, and territorial
governments all have a role in health care reform, and a strong majority supports
collaboration between governments on the health care file and a majority holds both
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governments responsible for the current state of health care. Canadians very much
support national standards and value the notion that there is one national system of health
care. However, they have a preference for the federal, provincial, and territorial
governments working together to set national standards, rather than having them imposed
by one order of government.
Canadians very much like the Canadian health care model, but most are
increasingly aware that it has not evolved to respond to technological and scientific
changes, nor to the way Canadians think and behave. Many Canadians have become
more informed and empowered health care consumers, and reforms to the health care
system must respond to this change. Any reform, however, must recognize that there
remain important socioeconomic differences on many questions: women, the elderly,
those who are more economically vulnerable, and residents of Atlantic Canada and
Ontario are especially resistant to changes that could damage accessibility and the public
system. Most Canadians, including the more economically secure, remain deeply
committed to a system that guarantees all Canadians access to good quality health care.
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Introduction
This study provides an overview of Canadian public opinion on the health care system.
All available Canadian public opinion polls since 1985 on health care were examined.
The evolution of opinion during this period, as well as current views and Canadians’ core
values related to the health care system, were identified. Searches were conducted at the
Parliamentary Library for all surveys commissioned by the government of Canada,
including those conducted by Health Canada, that have been made public in conformity
with Canada’s Access to Information Act. Searches were also conducted at the Canadian
Opinion Research Archive at Queen’s University. Canada’s major polling firms were
contacted subsequently for any recent polls they had conducted. In all, over 1,000 survey
questions conducted in over 100 polls were identified,1 only a small percentage of which
are presented in this report. Poll results were selected that are most representative and
best highlight the general trends and state of Canadian public opinion.
Canadians very much like the current Canadian health care system model, with 88%
saying that a strong, national, publicly funded system is important to them (Figure 1).
They have a strong symbolic attachment to it and overwhelmingly prefer it to others with
which they are familiar. Canadians strongly believe that the government should pay for
the health care of all citizens (Figure 2) and believe that the health care system is a public
good. During the past decade, however, Canadians have undergone a quite dramatic reevaluation regarding the performance of the system, concluding that the system has
deteriorated. While 61% of Canadians thought the system was excellent or very good in
1991 (and an additional 25% thought it was “good”), only 29% shared that view in 2000
(with an additional 34% saying it was “good”) (Figure 3).
Despite this perceived decline over the past decade and dissatisfaction with a number
of key aspects of the system, this report shows that Canadians continue to prefer the
Canadian model. They have reached a mature, settled public judgment, based on decades
of experience, that the Canadian health care model is a good one. Some public opinion
polls elicit off-the-cuff, transitory responses to recent events, while others represent
informed and relatively stable preferences that reflect people’s deeply held views. The
latter can be thought of as “public judgment” rather than just “public opinion,”2 and
1
2
This review examined surveys from CROP, Decima, Earnscliffe, Ekos, Environics, Goldfarb, IpsosReid, and POLLARA, as well as Canada Health Monitor/Berger Report, the Centre for Research and
Information on Canada’s annual “Portraits of Canada,” and quantitative and qualitative data collected
by the National Forum on Health (Government of Canada), the Saskatchewan Public Commission on
the Future of Medicare, and a number of international studies. Data presented in this report were
sometimes taken from reports that did not provide full details of results, such as the percentage of
undecided respondents. The author did not have access to micro-level electronic data for the purposes
of more detailed analysis. Thanks are owed to Earl Berger, Jason Brent, Fred Cutler, Darryl Bricker,
Donna Dasko, Frank Graves, and Andrew Parkin for making their polling data available. Thanks are
also offered to the public servants from Health Canada and the Privy Council Office who worked
diligently to make their data accessible. Karen Jackson, Judith Maxwell, and Sandra Zagon of the
Canadian Policy Research Networks also provided invaluable advice, as did Thomas McIntosh and
Pierre-Gerlier Forest, and the anonymous reviewers of this paper.
Daniel Yankelovich, Coming to Public Judgment: Making Democracy Work in a Complex World
(Syracuse: Syracuse University Press, 1991).
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Canadians’ Thoughts on Their Health Care System
although Canadians are still grappling with what to do in the future, they have reached a
public judgment about the past: they like Medicare and think it should be preserved.
This public judgment is reflected in the fact that the overwhelming response to
perceived deterioration has not been to reconsider the model, but, as shown in this report,
to call for governments to fix the system through better collaboration and management,
the injection of more funds, and small modifications. Canadians are aware of the
challenges faced by the system and are increasingly open to some experimental
modifications, but policy debate on potential changes should be predicated on the
presumption that Canadians like the Canadian health care model, have an attachment to
the present system, and would like improvements designed to reinforce the system with
which they are familiar, not undermine it through radical change. Canadians continue to
overwhelmingly prefer the Canadian to the American system and reject the proposition
that they would prefer to be treated in the United States if they had a serious illness. The
results indicate a strong symbolic attachment to the health care system and likely measure
to some extent the importance of Medicare to the Canadian identity, but they also show a
real preference for the Canadian over the American system (Figures 4, 5 and 6).
To best understand Canadians’ views regarding their health care system, it is useful to
recognize that Canadians have different views regarding: 1) Medicare as a symbol, 2) the
core principles of the Canadian health care model, 3) the system’s recent performance,
and 4) proposed future reforms. At the symbolic level, Canadians are highly attached to
the Canadian universal health care system, believe it is part of the Canadian identity, and
resist changes that would destroy this symbol. Canadians are also very supportive of the
core principles of Medicare as they understand them, such as universality, accessibility,
and comprehensiveness, and prefer their health care model to others. Canadians have
traditionally believed that access to medical care should be guaranteed by government
(Figure 7), and recent surveys have shown that 91% believe that care should be based on
need, 72% believe that Medicare embodies Canadian values, and only 8% believe that the
American system is better than the Canadian (Figure 8). However, in regard to the
performance of the system, over the past five years about two-thirds of Canadians have
consistently said that they sense deterioration and many are worried about the future
(Figure 9).
In regard to proposed reforms, Canadians prefer those changes that support the basic
model and principles; if larger changes are necessary, Canadians are far from settled on a
program of action. In a recent national survey, Canadians were presented with three
rather detailed options for sustaining the system. Only about 1 in 3 supported
privatization, and fewer than 1 in 10 supported cutting access to certain services; over
half supported investing significantly more money in the system (Figure 10), and while
significant increases in public funding may be unrealistic from a budgetary and public
policy standpoint, the results are a strong testament to the support for the system in all
regions of the country.
However, Canadians do not believe that more money alone is the solution, and from a
public policy perspective, significant increases in health care spending may be
unrealistic. During Saskatchewan’s public commission on Medicare, citizens were sent a
brochure outlining the challenges and choices confronting them and their health care
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Canadians’ Thoughts on Their Health Care System
system. Most recognized that adding more money alone was not the solution, while few
opted for increased privatization. The overwhelming consensus in Saskatchewan was in
favour of maintaining the core principles of Medicare, while making changes to the way
health care was managed and delivered (Figure 11). There is no reason to suspect that
Canadians in other provinces would respond much differently when faced with these
choices. In Ontario, for example, a recent survey found that 76% of respondents agreed
that adding more money alone was not sufficient to cure what ailed the health care
system (Figure 12).
Summary
Taken together, these results suggest very strong support for the system, a willingness
to pay to ensure quality, and a discomfort with either privatization or curtailing access to
services, although, as discussed in the main body of this report, support for some
privatization experiments has gone up in recent years in response to perceived
deterioration within the system as Canadians struggle to find ways to maintain quality
and access without large increases in taxes. Canadians have a great attachment to their
health care system and the concept of universal coverage. Medicare remains one of the
most important and valued symbols for Canadians’ sense of citizenship and most
Canadians see health care as a right. But the attachment Canadians have to their health
care system is not only symbolic: Canadians speak very clearly through the polls that, to
the extent that they know about other systems, they prefer the Canadian model, which
they understand to be a national, publicly funded system, defined by the core principles
of universal coverage, accessibility and treatment based on need. However, Canadians are
worried about the system’s future and do not believe that all is well, or that the system
can be fixed simply with the injection of more funds.
Many of the polls reported in this analysis provide the results of “easy questions.”
Increasingly, the choices facing Canadians and their governments are difficult choices
involving tough trade-offs. On these questions, the public opinion data are not as
extensive or as reliable. In the context of a poll, many respondents will express views that
highlight that “they want it all,” and it is only if presented with real world constraints that
Canadians will be able to address realistically the difficult choices in front of them. These
difficult choices require sustained public dialogue between parliamentarians, public
servants, interest groups, experts, and the general public. On particularly important
issues, governments require the consent of the public in order to move forward. Only
through a sustained public debate, where Canadians are asked to think about the future of
the system and choose between an array of realistic options, will governments be able to
build sufficient consensus to make major changes to the Canadian health care system. It
is true that many Canadians do not know the details of the health care system in the same
way policy specialists do. For example, almost 7 in 10 Canadians could not name one
principle of the Canada Health Act (CHA) (Figure 13). However, Canadians have had
personal experiences with the health care system, have great knowledge of its strengths
and weaknesses, and understand its basic principles even if they are unfamiliar with the
CHA. The fact that they may not have technical knowledge regarding the details of
legislation should in no way be taken to indicate that Canadians do not have meaningful,
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Canadians’ Thoughts on Their Health Care System
well-informed, and reasonable attitudes toward the system. They do, and these values
will be called upon to make decisions about its future.
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Canadians’ Thoughts on Their Health Care System
I
Background: Growing Concerns about Health Care
Health care has steadily risen as a priority issue for Canadians during the past five years.
It is important to recall that just 10 years ago, fewer than 1% of Canadians said that
health care was the most important issue, while that rose to about 50% of Canadians in
the year 2000 (Figure 14). There is no sign that this priority is going to abate in the short
term, despite renewed concerns regarding the economy and security in the wake of the
attacks of September 11. Although concerns about these issues rose in the autumn of
2001, they have joined, rather than replaced, health care as a preoccupation for
Canadians.
Many Canadians are quite pessimistic about the future of the health care system, with
most believing that the system will cost more, that individuals will have to pay for more
services themselves, and that there will be a greater demand on the system (Figure 15).
Most also believe we are losing ground, and only 14% believe we are making progress
(Figure 16). Although some of these surveys were conducted before the new federal
injection of funds in 2000 and 2001, there is no sign that these funds addressed
Canadians’ concerns regarding the long term, with 88% of Canadians still believing that
there is a major funding crisis – or will be one in the near future (Figure 17). Only 37% of
Canadians agree with the statement that Medicare is just fine the way it is – a remarkably
low percentage considering the great attachment that Canadians have to the system
(Figure 18). These numbers suggest that Canadians are very much aware of problems
within the system. A decade ago, around the time of the National Forum on Health,
Canadians were very satisfied with the system’s performance, which is no longer the case
today.
In 1988, Canadians more than citizens in a number of other countries thought that
their health care system was in basically good shape; by 1998 that was no longer the case,
with a strong majority of Canadians (79%), like a strong majority of citizens of the
United Kingdom, the United Stages, Australia, and New Zealand, saying the system
needs some “major changes” or “needs to be entirely rebuilt” (Figure 19). Whereas a
decade ago, Canadians stood out as uniquely satisfied with their health care system, today
their judgments are quite comparable to those of citizens in other countries. Still, only
23% of Canadians believe that the system needs to be “entirely re-built,” highlighting that
Canadians will go along with changes that support rather than undermine the Medicare
system.
Canadians do not blame one political party or one order of government. A variety of
surveys show that Canadians’ negative judgments about the performance of the health
care system are generalized to all governments (Figures 20 and 21), with little interprovincial variation, although the provincial governments have been perceived to be
somewhat more responsible (Figure 22).
A remarkably high 20% of Canadians who have used the system in the previous year
judge the quality of care they received as “fair” or “poor,” only 78% agree that their
experience with the system was positive, and almost 1 in 4 say they are not confident that
they could receive the care they needed if they became ill (Figures 23, 24 and 25).
Among Canadians who used the health care system, the number who said they were
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Canadians’ Thoughts on Their Health Care System
unable to access the health care they needed now stands at 15%, up from 2% in 1989
(Figure 26), with little regional variation (Figure 27), again highlighting a systematic
national problem, rather than one that can be readily attributed to one government or
political party alone. While the vast majority believe that the system can meet their needs,
they are more skeptical about the system’s ability to meet the needs of all (Figure 28),
and there has been a significant increase in the number of Canadians who have had
negative experiences with the system in terms of access and quality.
An increase from a paltry 2% to a significant 15% in a decade, and the fact that
somewhere around 1 Canadian in 5 (depending on which survey one examines) was
unsatisfied with their experience with the system must be seen as a sign of concern. If we
look at the percentage of Canadians who said they had difficulty accessing the health
services they needed – rather than the percentage who said they were unable to access
services – the number jumps to 34%, up from 18% in 1989 (Figure 29). Canadians are
increasingly feeling stresses on their system, and they report more difficulty seeing
specialists than residents of the United States, the United Kingdom, Australia or New
Zealand, with 46% saying they had had at least some difficulty (Figure 30). Canadians
are also concerned about waiting times at emergency rooms and for other procedures
(Figures 31 and 32).
Summary
Although Canadians are worried about the system and judge it to be of lower quality
than it was a decade ago, most continue to be satisfied with the quality of care they have
received, and when asked if they are confident that they will be able to get the care they
need, they say “yes.” But Canadians are increasingly pessimistic about the future of the
system, are increasingly worried about getting access to the care they need in a timely
fashion, and a growing number of Canadians have been unhappy with their experience
with the system during the last three years.
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Canadians’ Thoughts on Their Health Care System
II
Canadians’ Evolving Values in Regard to Health Care
Canadians’ New Values
The past two decades have seen a gradual shift in Canadians’ values toward preferring
greater personal autonomy, empowerment, and the desire to make choices on their own in
a wide range of areas.3 Canadians are today more resistant to the collective provision of
services generally than they were two decades ago, and have increasingly adopted a
mentality that expects responsiveness and a high quality of service, delivered in a manner
that meets their individual needs. Although these represent a real evolution in values, the
commitment to the collective provision of health care, as we have seen, remains strong.
The importance of accountability as a general value orientation has also increased in
the minds of many, with Canadians expecting greater accountability from governments to
citizens. This accountability implies more efficiency from government, a better
management of public funds, and fiscal responsibility, particularly after living through
the deficits and subsequent cutbacks of the early 1990s. Canadians, however, have not
abandoned their values regarding sharing, compassion, and community. For example,
83% of Canadians support the equalization program, designed to ensure that all
Canadians, regardless of the wealth of their community, have access to good quality
health care and schools (Figure 33). The National Forum on Health identified compassion
as one of Canadians’ fundamental values, and this remains true, though Canadians are
now more likely to express this in ways consistent with greater autonomy for individuals.
The shift in values toward a greater sense of personal autonomy, which has been
more prominent among men and the well-off, is the background against which many
choices about health care must be made: how does one maintain a universal, publicly
funded system, while offering Canadians more choice and autonomy? Any proposed
reform must increase rather than decrease accountability, while remaining fiscally
responsible. It must also increase patients’ autonomy and choice, while at the same time
preserving the key elements of Medicare and the public, collective system, which values
compassion and does not abandon the more vulnerable members of the population.
Acting on Values
Canadians are increasingly engaging with their doctors about their treatments (Figure
34). They are increasingly accessing health information on-line and discussing this
information with their family physician as many become more empowered health care
consumers. Canadians are increasingly prepared to engage with their doctor on-line,
particularly for more routine matters (though there are predictable sociodemographic
differences on these questions).
Although the trend is unmistakable and the transformation of the habits of some
Canadians over a short time period is quite dramatic, one must be careful not to overstate
the extent to which Canadians are currently prepared to use the Internet for health related
3
Neil Nevitte, The Decline of Deference (Toronto: Broadview Press, 1996).
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Canadians’ Thoughts on Their Health Care System
matters: in 2001, 43% of Canadians had visited a health related site on the Internet, and
of these, 67% would be prepared to make appointments with their physician using e-mail,
which still represents only 29% of all Canadians (Figures 35 to 38).4 Among Canadians
over the age of 65, many of whom are frequent users of the health care system, fewer
than 5% are prepared to interact with their physician via e-mail.5 Very few Canadians
actually buy health products on-line (Figure 39). The vast majority of “alternative
medications” used consist of vitamins, though 16% of Canadians claim to have used
homeopathic remedies in the previous 6 months and 38% claim to have used herbal
remedies over the same time period (Figure 40). Chiropractors, massage therapists,
naturopaths, herbalists, acupuncturists, and homeopaths are the most frequently used
alternative health providers (Figure 41), with about 1 in 4 Canadians in 1999 saying that
they had used some form of alternative treatment, though one must keep in mind that
most of these people are nonetheless more reliant on the traditional medical system.
Women, the young, the well-educated, and the well-off are most likely to use these
alternative health providers. Use of alternatives medications increases as one travels west
in the country (Figure 42).
All of these behaviours highlight the changing values and capabilities of Canadians,
and the trend is likely to continue. Reforms must acknowledge this evolution and respond
to it. Yet these behaviours are not evidence that Canadians have gone running to
alternative or non-traditional procedures at the expense of traditional medicine: most
people go on-line to look for mainstream health information and use traditional sources
(Figures 43 and 44). Moreover, many Canadians are still quite wary of the Internet, and
many Canadians, particularly older and more economically vulnerable Canadians,
continue to adopt a passive, deferential attitude when dealing with their physicians and
the health care system.
4
5
These figures may slightly overestimate actual Internet use. According to another source, only about
one Canadian in four had looked for health related information on-line in 1999 (Statistics Canada,
Innovation Bulletin Analysis, Vol. 3, no. 1, February 2001: 10).
C. Silver, Internet Use Among Older Canadians, Connectedness Series no. 4, Statistics Canada, 2001.
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Canadians’ Thoughts on Their Health Care System
III
Sustainability
Support for the Canadian Health Care Model but Growing Concerns
It has become commonplace to state that Medicare has become a core component of
Canadians’ national identity and that it has become symbolically important to Canadians.
While this conceptualization is accurate, it risks distracting us from a more important
point: Canadians overwhelming prefer the Canadian health care model because they think
it is better and fairer.
The five principles of the Canada Health Act (CHA) continue to be overwhelmingly
supported, with about 4 in 5 Canadians saying that universality, accessibility,
comprehensiveness, and portability remain “very important” (Figure 45), although, as
discussed earlier, most Canadians cannot recall these principles if asked an open-ended
question in a survey. The importance of the principle of public administration has
declined in recent years, though 56% continue to say it is “very important,” with many
more saying it is “somewhat important.” Support for “public administration” has declined
over the past two decades, but it is still supported by a strong majority of Canadians, and
polls reveal little support for abandoning public administration or other principles of the
CHA (Figure 46).
In 2000, even when asked about maintaining health care entirely as a public program
– which is somewhat misleading because the health care system is not currently entirely a
public program6 – only 36% opt for some private elements. This is strong testament to the
deep, residual support for the principles inherent to the system. However, over the past
year, support for a program that is entirely public has slipped, with 42% of Canadians
now supporting a system that has some private elements (Figure 47). Quebec and British
Columbia are the most supportive of private elements, while Ontario and Atlantic Canada
remain most resistant. This suggests that increasing numbers of Canadians support a
system with some private elements so long as the core of the system is maintained. This
increased support may reflect the fact that Canadians are very worried about the
deterioration within the system, and may also reflect the fact that Canadians increasingly
understand that the system is not “entirely public” at the moment.
When Canadians are asked, they consistently say that we should not cut spending on
health care. In 2001, 78% of Canadians said we were not spending enough on health care,
while only 4% said we were spending too much (Figure 48). Canadians consistently say
that our system does not cover too many services (Figure 49) and are willing to pay to
ensure quality. In the mid-1990s, Canadians were very focused on putting more money
back into the health care system (Figure 50), but, as discussed in the next section,
Canadians now recognize that reforms, not only money, are required.
Concerns about the quality of care, understood as timely access to the best quality
care, have increased in recent years. “Quality” has gradually become more important to
6
The system is not “entirely public” because many non-essential services are not covered by Medicare,
such as some eye exams, and many products are not covered by Medicare, such as prescription
medications. Individual Canadians can also pay for private insurance or can pay out-of-pocket for
things like private rooms in hospitals or additional health care attendants.
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Canadians’ Thoughts on Their Health Care System
Canadians in the past seven years because they have sensed deterioration in the system.
Some of Canadians’ highest concerns relate to waiting times, a lack of the most
sophisticated equipment, and shrinking staffs (see Section IV, Tough Choices, Figures 91
and 92). “Quality” and “equal access for all” are now judged to be of equal importance
(Figure 51). Yet in 1998, 64% of Canadians agreed that “we need to maintain equality of
access, even if it means that we cannot have the highest quality care” (Figure 52). And as
discussed below, access remains particularly important for the more economically
vulnerable (see Section VII, Figure 119), a difference that cannot be overlooked in any
proposed reform.
What should we make of these ambiguous findings? It is clear that polling questions
related to the trade-off between access and quality are very difficult to interpret because
just about all Canadians are deeply committed to both. Therefore, questions that ask
Canadians to choose between the two principles provoke somewhat artificial messages
because Canadians have not really thought about how to strike a balance between them.
Most older or low income Canadians instinctively choose “access” because many sense
that they would be negatively affected by a system that did not guarantee equal access for
all, while many wealthier Canadians choose “quality” because they are increasingly
concerned that the best available procedures and technology are not being used because
of cost considerations. Nonetheless, the two clear messages emerging from these polls are
that Canadians have become increasingly concerned about the quality of care provided by
the health care system, and that quality and access can be understood as the two key
principles of the health care system to which most Canadians are deeply attached.
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Canadians’ Thoughts on Their Health Care System
IV Proposed Improvements
Canadians and their governments need to make choices about the future of their health
care system, but available survey data reveal that Canadians have not yet made these
difficult choices and have not come to terms with some of the realities of escalating costs.
Even though Canadians say that Medicare should cover more services, when asked how
one could pay for this, most Canadians are not willing to choose between a variety of
realistic options. For example, in 2000, when residents of Saskatchewan were presented
with scenarios for generating revenues for the health care system, 41% refused to choose
between the options (Figure 53). Many Canadians would prefer to find a way to preserve
the health care system without cutting spending in other key areas, raising taxes, or
privatizing key components of the system.
In a national survey, few Canadians said they thought increased spending on the
health care system should come from taxes or other social programs. Instead, they
supported taking money from other government programs – something which
policymakers may find unrealistic, or making those who can afford to pay do so –
something which opens the door to means-testing (Figure 54). Both of these options –
“get the money from other government programs” and “make the wealthy pay” – are easy
replies in the context of a survey, but may not offer viable guidance for reform. While
Canadians have arrived at a settled public judgment that they prefer the current model,
and while they are increasingly aware of problems within the system and are prepared to
consider reforms, they have not yet arrived at a judgment about what needs to be done.
More Privatization?
Canadians are only beginning to focus on the subtle distinctions between various
models that include additional private elements, such as private delivery, user charges,
private insurance, or a “two-tiered” system. The distinction between privately operated
clinics providing basic health care to everyone but paid for out of public monies, as
opposed to a parallel system in which individuals can pay, are terribly important public
policy distinctions, yet Canadians have not come to a public judgment on these issues.
For now, Canadians continue to generally resist privatization, but grasp for proposals that
can protect and improve the public health care system.
In general, about one-third of Canadians say they support a “two-tiered” or “parallel”
system. In 2001, 31% of Canadians offered support when the option was framed as
relieving pressure on the existing public system, up from 26% in 1999 (Figure 55).
Depending on the question, 31%, 29% or 33% express support for a parallel private
system (Figures 56 and 57). However, one recent poll found the public more evenly
divided on a “two-tiered” health care system, but there are reasons to be skeptical that
support is this high. First, the question asks participants to agree or disagree that it is
“alright” if Canada introduces two-tiered medicine, a much softer wording than
“support.” Second, even with this softer wording, 38% of Canadians continue to
“strongly disagree” with the statement, while only 19% “strongly agree,” highlighting the
intensity of opposition and the lack of intensity among those who say they support a twotiered system (Figure 58).
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Canadians’ Thoughts on Their Health Care System
There appears to have been little movement in opinion between 1996-2001 on the
question of whether Canadians should be able to pay extra money to get quicker access,
standing at 36% support, though in British Columbia and Alberta people are about evenly
divided on the question (Figures 59 and 60). A 1998 poll pegged support for “queue
jumping” even lower, at 24% (Figure 61). The Berger Report found strong disagreement
with the proposition that one could pay to wait a shorter time (46% of Canadians
“strongly disagreeing” with many more “somewhat disagreeing”), and this jumps even
further to 67% when this is phrased as “people paying to go to the front of the line”
(Figure 62). Nonetheless, most people think they personally would be okay if they could
pay for quicker access (Figure 63), presumably because most Canadians believe they
could afford small fees for health care. This implies that Canadians’ commitment to a
one-tiered system is not only based on worry about how they would fare in an alternative
system, but is also an expression of their values. Most Canadians have a deep
commitment to one system, where all receive equal access to treatment. They recognize
that the best way to nurture and preserve the system is to have all Canadians – rich and
poor, young and old – participating in the system.
The strong opposition to a “two-tiered” health care system is in tension with
Canadians’ belief that individuals should be able to use their money as they see fit to
protect their own health. Canadians are sensitive to the desire among many Canadians to
spend their own money if they are facing a lengthy wait for treatment. While some polls
have shown opposition to queue jumping, when Canadians are faced with the
proposition: “should Canadians be allowed to have the option of using private facilities
with their own resources if they cannot get timely access in the public system,” 73% say
so (Figure 64). We see here the crucial tension: most Canadians want to nurture the
public system, but most also fully sympathize with someone who wants to spend their
own money to get the care they need, a tension not at all easy to resolve.
A good deal of polling was done on Alberta’s Bill 11, which pays private clinics out
of public money. The present report is not particularly interested in the details of Bill 11
itself, but the polling on the issue was quite detailed and provides insight into what
Canadians think about real-world privatization models. Canadians at first appear fairly
evenly divided between supporters and opponents of a Bill 11 model (Figures 65 and 66),
which contrasts markedly with the generally strong opposition to a “two-tiered system”
discussed above. Yet it is important to note that the questions asked in Figures 65 and 66
referred to private clinics paid for out of public funds, implicitly focusing on nonemergency services designed to relieve pressure on the public system – a modest version
of privatization. Furthermore, opposition is far more intense, with a far greater number of
Canadians “strongly” disagreeing than “strongly” agreeing to the model. Nonetheless, the
numbers do indicate some acquiescence toward some amount of privatization. Canadians
are not enthusiastic about it, and they continue to believe that the Canadian health care
model is the best available, but when defined in narrow terms, Canadians can be made to
acquiesce, that is, to say that they “somewhat support” some private options within the
context of a public system.
Another testament to the support Canadians have for their health care model is that
arguments in opposition to Bill 11 are far more persuasive than those in support (Figures
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Canadians’ Thoughts on Their Health Care System
67 - 70). These included the argument that Bill 11 undermines the principle of
universality and moves us closer to an American style health care system. About 4 in
10 Canadians find the arguments against Bill 11 very effective, with many more finding
them somewhat effective. Canadians are also much more likely to strongly agree with
arguments in opposition to Bill 11, such as the importance of putting money into the
public rather than the private system. Only about 1 in 4 or 1 in 5 find the arguments in
favour of Bill 11, such as improvements in the speed of service and the cost to the
country, very effective. Likewise, Canadians are less likely to strongly agree with
arguments in favour of Bill 11. The only argument which attracts a good deal of strong
agreement is the one that posits that Canada should “do anything that improves the
quality of health care, including paying private facilities,” highlighting how Canadians
are willing to acquiesce to a variety of things in the context of a poll when they are
framed as improving quality and responding to perceived deterioration. These findings
mirror the similar findings in regard to arguments regarding privatization generally,
where arguments in opposition are greeted with much more agreement than arguments in
favour (Figures 71 and 72).
User Fees?
Many Canadians (almost half in 1995) expressed support for user fees for hospital
visits (Figure 73). The reasons behind this support require scrutiny. Canadians have some
openness to user fees because they believe these will discourage overuse by those who do
not really require care (93% of Canadians offered this view, according to the Berger
Report in 1996). As found in qualitative research, some Canadians support user fees
because they believe they are a useful way to raise revenue and ensure the long-term
viability of the system. There is greater support for user fees for those who use the system
at a higher rate than the norm (Figure 74). However, although Canadians express support
for user fees in certain contexts, Canadians do not really want to “bill the ill” and the
notion that Canadians would support extra billing cancer patients for their frequent
chemotherapy seems far-fetched. If told that some people were not getting the care they
needed, almost all express the view that the community or government should pay
(Figure 75). What these poll results show is that many Canadians believe that there are
those who take advantage of the system. Canadians’ support for user fees can be
understood as their support of a relatively pain free way to “save the system,” particularly
at a time when many Canadians have become increasingly used to user fees for a variety
of previously free public services.
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Canadians’ Thoughts on Their Health Care System
Home Care and Pharmacare?
Canadians have not reached a consensus on whether they support the expansion of
publicly funded pharmacare and/or home care. Home care seems to be more widely
supported than pharmacare (Figure 76). This is in part because many Canadians – about
half, according to the 2000 Berger Report – have private insurance that covers their
prescription medication, and in part because a growing number of Canadians – now up to
25% – have to take care of relatives at home (Figure 77), usually incurring financial costs
(Figure 78). When told that prescription drugs are publicly insured in most other
countries, only 27% still believe that there should be no pharmacare program in Canada
(Figure 79), again highlighting that many Canadians, in an ideal world, would like the
system to cover more services than it does presently. However, when reminded of
potential costs, most believe that only drugs for serious illnesses should be covered
(Figure 80). Many proposals for new national programs are greeted favourably in polls
because trade-offs or costs are not made explicit in the question.
Primary Care Health Service Teams?
One option for reform of primary care that has been discussed by health care
professionals is the more extensive use of teams of practitioners. After being presented
with some details regarding this model, most Saskatchewan residents found the model
initially appealing (Figure 81). In particular, the model is attractive because it appears to
address issues such as the unnecessary use of the emergency room and frequent and
unnecessary visits to one’s family physician. Most Canadians say that they find it
acceptable to see a specialized nurse rather than a doctor for routine procedures
(Figure 82), and they have indicated that they are generally attracted to the idea of their
doctor working in a larger team (Figure 83). In general, there appears to be a good deal of
openness to the idea of primary health service teams, though Canadians have not yet
thought much about the issue. Canadians might oppose a change that threatened their
relationship with their family physician, although there are no reliable data on this precise
question. The overwhelming majority of Canadians continue to have a family physician
and any move to the implementation of health service teams would need to allow
Canadians to choose their own family doctor and develop the level of trust that comes
with such a relationship.
The Future of Hospitals?
Many Canadians continue to believe that the preservation of their local hospital is
crucial to good quality health care. Although data on this question are sketchy, the
Saskatchewan Commission found that residents of smaller communities were very
resistant to the idea of closing smaller, rural hospitals, despite growing evidence that
these provide a poorer quality of care (Figure 84). Yet there is clearly an ambivalence to
Canadians’ views. A surprisingly large majority said that more money should be invested
in alternative systems of delivery, such as home care and community-based clinics, than
in the existing network of hospitals (Figure 85). Moreover, while many support
maintaining their local hospitals, most recognize the advantages of combining the
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Canadians’ Thoughts on Their Health Care System
services of some hospitals and possible improvements in quality, and are not overly
worried about travel time or a lack of personal attention (Figure 86). These data suggest
that there is more openness to alternative systems of delivery for health care than
suggested by the data collected during the Saskatchewan Commission.
Extending Life?
When Canadians were asked in 1999 about how important a number of goals were for
the health care system, providing life-extending treatments scored much more poorly than
a number of other objectives, with only 33% of Canadians saying it was a very important
priority (Figure 87). It is a difficult subject for political leaders to discuss, but one that is
on the minds of many Canadians, and one that will need to be addressed in a public way
in any serious discussion of health care reform when making difficult choices regarding
which medical services are fully covered by the public system: how much effort should
be invested in prolonging life by a few months, if this does not represent an improvement
in the quality of a patient’s life? In 1995, 63% of Canadians said they had at least some
support for the idea of doctor assisted suicide, again highlighting that many Canadians
are not at all convinced that extending life whenever possible is the wisest choice
(Figure 88).
A “Wellness Agenda”?
Canadians consider the promotion of health and wellness an important goal (see
Figures 87 and 89). This does not mean that they would like the government of Canada to
send out information on how to stay healthy, but they do support the government
participating in the elaboration of a strategy that promotes Canadians’ long-term health.
Qualitative and quantitative research have consistently shown that Canadians believe the
job of the health care system is not only to treat disease when patients walk through the
door of a hospital, but also believe that the health care system has a responsibility to be
actively engaged in implementing strategies that improve the overall health of Canadians.
The Saskatchewan Commission on the Future of Medicare found that only 29% of
respondents believed that the health care system had no role in the general promotion of
health.
Tough Choices
Most Canadians express support for a large number of potential improvements in the
short term, such as guarantees on waiting times, the purchase of more equipment, and
telemedicine (Figure 90). But that Canadians express support in the abstract for attractive
proposals is not surprising. The key question for policymakers is which attractive
proposals are the most popular with Canadians and accorded the highest priority.
In qualitative research work in September 2000, Canadians were asked to rank a
number of goals in terms of their overall priority (Figure 91). Adequate numbers of
nurses, doctors, and specialists was deemed to be the most important goal, followed by
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Canadians’ Thoughts on Their Health Care System
the availability of services 24 hours a day, expanded home and community care,
expanded support for community health clinics, better access to modern medical
technology, and improved access to specialists. Pharmacare, health promotion activities,
increased performance measurement and reporting, and expanded use of health
information technology were given lower rankings. Participants were then presented with
a variety of facts and discussion about the health care system and then asked to re-rank
the priorities. Although there were some significant shifts, the four items judged to be of
low importance continued to rank at the bottom of Canadians’ list of priorities, and the
provision of adequate numbers of doctors, nurses, and specialists across the country
continued to be the most important goal (Figure 92). A large survey conducted around the
same time produced broadly similar results, suggesting that these results represent a fairly
accurate reflection of Canadians’ current priorities in regard to health care.
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Canadians’ Thoughts on Their Health Care System
V
Accountability
In this section, Canadians’ views regarding accountability will be examined. Canadians
have come to expect greater accountability from the government generally and the health
care system specifically, meaning that they expect more controls on how money is spent
to ensure that it is spent in the most efficient way possible, and that there are transparent
mechanisms for verifying decisions on spending. This increased preoccupation with
accountability applies to the system as a whole, but to doctors and patients as well, with
Canadians instinctively supportive of mechanisms that might discourage unnecessary
procedures or treatments.
Canadians generally believe there is inefficiency in the system, but the perception that
there is a great deal of unnecessary administration and poor hospital management went
down during the early 1990s. Canadians are in the process of recognizing that the ability
to “cut red tape” will not magically solve all the problems with the health care system.
On the other hand, the number who say that people use services unnecessarily (87%
agreement in 1995), that doctors prescribe unnecessarily (73% agreement), and that many
patients would do as well at home (65% agreement) has been on the rise since 1989
(Figure 93).
When Canadians say that there is waste in the system, this is not a meaningless belief
that we should “cut red tape.” Qualitative research has shown that Canadians have in
mind two specific problems: patients using the system unnecessarily, and doctors
prescribing, giving referrals, and performing procedures unnecessarily. Almost 2 in 3
Canadians agreed that doctors sometimes encourage patients to come for more visits than
necessary (Figure 94) and a similar number believed that individual Canadians misuse the
system (Figure 95). Identifying the policy mechanisms to deal with these practices would
likely find a receptive audience.
However, as policymakers elaborate models to curtail unnecessary practices, an
opposing force arises in public opinion: Canadians might not be prepared to limit their
own doctors’ autonomy to give referrals and prescribe on their behalf. The evidence from
Saskatchewan highlights this tension. Although most residents of Saskatchewan (by a
margin of 75 to 12%) were conscious of the need to ensure that prescribed services are
actually necessary (Figure 96), a slim majority of Saskatchewan residents also opted to
make as many new procedures available as possible (Figure 97). The value tension is
clear: Canadians are looking for ways to augment accountability within the system and
ensure that treatments are ordered only when necessary, but they also have a commitment
to the highest quality system, where their doctor can offer them an array of the newest
procedures. There is also evidence that Canadians are even prepared to try experimental
treatments when conventional medicine has not worked (Figure 98). Again, the value
clash is clear: although there is a desire to increase accountability, Canadians also want to
retain a good deal of autonomy for themselves and their family physician to pursue
whatever treatments are available. Polls cannot resolve the dilemma faced by
policymakers: how can one make sure that all of the newest procedures are available,
while retaining accountability and keeping costs under control?
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Canadians’ Thoughts on Their Health Care System
According to the Berger Report of 1999, 36% of Canadians said they had visited an
emergency room in the previous six months. Of these, 37% said they did so between
6 pm and midnight (23% between 6 am and noon, 28% between noon and 6 pm, and 12%
between midnight and 6 am) (Figure 99). The timing of these visits – people have gotten
off work but their family physician is not available – suggests that many are using the
emergency room for non-emergency problems when they cannot see their family doctor.
Over 80% of Canadians would support alternatives, such as a telephone service or the
availability of 24-hour walk-in clinics with doctors (Figure 100). Support for user fees
and information campaigns is much lower.
Canadians are also supportive of accountability and performance measurement to
help ensure efficiency. However, “accountability measures” are not a top priority:
Canadians say they like the idea of community health reports, particularly in regards to
the performance of the system on such things as waiting times rather than the health of
Canadians, again highlighting Canadians’ desire to act as informed and empowered
health care consumers (Figures 101 and 102). However, only 19% believe that report
cards on Canadians’ health should be a higher priority than other key health care goals
(Figure 103).
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Canadians’ Thoughts on Their Health Care System
VI The Federal Context and the Role of Government
The role of government remains central in any proposed reform: 81% of Canadians
believe that the federal government should be actively involved in the health care system
(Figure 104). To provide just one example: about 2/3 of Canadians believe that if a
national pharmacare programme is introduced, national rather than provincial principles
are required (Figure 105). By a margin of 59 to 39%, Canadians believe that the federal
government has a key role in sustaining the system and ensuring standards, not merely
writing cheques (Figure 106). This support for federal involvement exists despite the fact
that Canadians are generally uncertain about the current size of the federal contribution to
health care, with guesses ranging widely on how much health care money comes from
Ottawa (Figure 107).
The perception that the federal government has a key role in health care became
stronger during the 1990s, with 44% saying that health should primarily (or exclusively)
be an area of federal responsibility, and another 15% saying it should be under the
authority of both (Figure 108), though this underestimates the percentage of Canadians
who prefer collaboration because the “both” response was not offered and had to be
volunteered by the respondent, something most do reluctantly. When asked which
government should take the lead in reform, with a distinct “both” option presented to
them, Canadians strongly believe that health should be the responsibility of all
governments (Figure 109). Other surveys showed that Canadians strongly believe that the
federal, provincial, and territorial governments all have a role in health care reform, with
68% opting for collaboration, and a majority holds both governments responsible for the
current state of health care (Figures 110 and 111).
Canadians very much support national standards and value the notion that there is one
national system of health care (Figure 112). However, they have a preference for the
federal, provincial, and territorial governments working together to set national standards,
rather than having them imposed by one order of government (Figure 113). In a large
number of surveys, Canadians have shown that they are very divided on the question of
withholding funding from provinces that do not conform to the Canada Health Act. It is
an issue on which values clearly come into conflict. Canadians very much believe in
national standards and their enforcement, yet they are also concerned that withholding
funds could damage the quality of the health care system in these provinces and resist one
government imposing its will on other governments. It is for this reason that Canadians
are much more supportive of all governments working together to make determinations
about national standards and enforcement than having the federal government act alone in
these matters. Canadians in all provinces are divided on the question, though in 1995
Quebecers were most supportive of withholding funds from provinces that do not comply
with the CHA (Figures 114 and 115).
Canadians continue to have great confidence in health care professionals and 97%
believe that they should have an important role in setting policies and ensuring the best
possible care, while only about 70% of Canadians believe that governments should have
an important role (Figure 116). Although the public recognizes that governments have an
important role, Canadians believe that the involvement of health care professionals is
essential for success.
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Canadians’ Thoughts on Their Health Care System
VII Different Canadians, Different Views?
There are important differences of opinion on most health care questions between
different income groups and between men and women. Women and those with lower
incomes are more likely to put a higher priority on social programs generally than other
government priorities such as tax reductions or debt reduction: 68% of women believed
that investing in social programs should be the first priority, while only 49% of men
shared this view. Likewise 71% of Canadians with annual incomes less than $20 000
prioritized investing in social programs, while only 45% of those with incomes greater
than $80,000 did the same (Figure 117). Women generally value more than men the
collective provision of many services, and many polls show that this is the case with
health care. Women are also more likely to be primary caregivers for children and elderly
parents, thus having more interaction with and reliance on the public system. Worry
about the health care system, health care as an issue, and opposition to all forms of
privatization are stronger among women than men.
More economically secure Canadians are much more open to privatization, more
freedom of choice, and more autonomy for individual patients to seek and pay for
different services. Canadians deeply value both universality/accessibility and high quality
care. However, if forced to choose between these two equally important principles,
wealthier Canadians are more likely to opt for quality (and the right to pay to ensure
quality) while those who are less financially secure opt for universality. Senior citizens in
Canada are particularly preoccupied with equal access, by a margin of 58 to 23%
(Figure 118), in part because most are on fixed incomes. Those with lower incomes
clearly recognize that the quality of the public system benefits from the participation of
all Canadians, and foresee that they would suffer most under reforms that move toward
more privatization. Canadians with lower incomes are much more supportive of
extending Medicare to cover prescription drugs (Figure 119), in part because they are less
likely to be covered by private or employer insurance (about half of Canadians currently
have some form of insurance beyond Medicare). Canadians with private insurance are
much more supportive of privatization and copayment schemes of all kinds, and less
supportive of pharmacare because they personally have no need for such a programme.
Regional differences on most questions are not pronounced. Those in British
Columbia and Alberta are somewhat more supportive of privatization options than
elsewhere in the country. Those in Atlantic Canada and Ontario are somewhat more
committed to the existing system. Those in Quebec have somewhat less attachment to the
system as a core component of their identity and are therefore consistently more open to
some forms of privatization. Nonetheless, the main conclusion, based on an examination
of thousands of polling questions, is that the inter-regional similarities far outweigh any
minor differences of opinion. For example, a poll taken in 1999 during intense debate
surrounding Bill 11 in Alberta found almost no difference of opinion between those in
Alberta and those elsewhere in the country, though understandably the rate of uncertainty
was higher outside Alberta (Figure 120).
- 20 -
Canadians’ Thoughts on Their Health Care System
VIII
The Path Forward – What Are Canadians Saying?
Medicare remains a key symbol of citizenship and identity for most Canadians, and the
vast majority support the principles that define the system as embodied in the Canada
Health Act. Yet Canadians have become increasingly concerned about deterioration and
are now open to considering reforms, though their strong preference is for innovations
and renovations within the core public system that preserve the Canadian health care
model. A majority of Canadians are looking to the federal, provincial, and territorial
governments to act collaboratively as guardians and champions of the public system, but
to work toward innovation to respond to what Canadians increasingly acknowledge are
difficult pressures. Most Canadians hope that reforms will be designed to guarantee equal
access to the core elements of the public system, and that excellence will be preserved
within the public system, all the while augmenting Canadians’ ability to make choices
about their own health care services. During this process of reform, Canadians very much
support governments working in partnership with one another, with health care
professionals, and with the general public.
There is a deep commitment to universality, equal access, and quality care. Many
Canadians have some openness to various schemes, including user fees and additional
insurance options within the overall context of Medicare, so long as these changes are
designed to preserve the core components of the Canadian health care model. Canadians
are deeply committed to the idea that their fellow citizens should not be denied good
quality health care, but are currently prepared to entertain various proposals that
realistically improve the efficiency of the system. Primary health care reform could find a
receptive audience. The notion of “purchasing upgrades” may also be consistent with
Canadians’ values. Few Canadians are comfortable with the idea of the upper-middleclass and the insured driving a health care Mercedes while one-third of the population is
consigned to riding around in a 10-year-old Sprint. However, Canadians are likely
comfortable with the idea that everyone will be driving a good quality health care car,
with those who are willing to pay having the right to purchase reclining seats and a
sunroof. The question of course for public debate and policymakers is: Which core
elements are the standard features and which are extras?
Canadians are more supportive of individual autonomy and choice, and are more
resistant generally to collective provision of services. More Canadians now seek out
information on their own, and increasingly make much more diverse health care choices,
some of which are outside the current health care system. The increasing diversity of
Canadians, and their desire to exercise more freedom of choice in many aspects of their
lives, represents a challenge for a “one-size-fits-all” model of health care delivery.
Having said that, Canadians remain deeply committed to the collective provision of
health care and universality for the health care system, though within that system there is
now increasingly a tension as more informed, more autonomous Canadians, who are
often better off financially, demand more control and more ability to make choices. The
existence of many empowered health care consumers, however, should not distract us
from the fact that many other Canadians remain traditional and passive in their
interactions with the health care system.
- 21 -
Canadians’ Thoughts on Their Health Care System
Health care is currently the most important issue to Canadians, and the public health
care system is the most important government program for most Canadians. Health care
is unique in that it is an issue that touches on questions of national identity, deeply held
values, and people’s direct interests. Sustained public dialogue will be required before
changes can be made: Canadians are deeply attached to, invested in, and reliant on the
health care system, and any change will affect the lives of virtually all Canadians.
Changes to the health care system are about far more than values and identity – the issue
is also very much about Canadians’ basic interests and needs, their ability to get care, and
how they think this can best be accomplished.
Many Canadians are worried about the future of the health care system. Over the past
five years this has meant that Canadians have become more open to health care reform.
Canadians are seeking ways to combine the excellence that they have been used to but
feel has been lost in the past decade, with the maintenance of accessibility and
universality that they judge to be the hallmarks of the public system. However, Canadians
are less ideological than they were a decade ago and are more open to considering a range
of proposals. Canadians have, however, reached a fairly strong consensus on two things:
money alone is not the answer to the problems, and the principles of Medicare should be
maintained. The Canadian public strongly supports the principles of the Canada Health
Act, but recognizes that changes may be needed to preserve and improve the quality of
health care in Canada.
- 22 -
Canadians’ Thoughts on Their Health Care System
Appendix
- 23 -
Canadians’ Thoughts on Their Health Care System
- 24 -
Canadians’ Thoughts on Their Health Care System
Figure 1: Support for Canadian Health
Care System Model
How important is it to you to have a strong national system of publiclyfunded health care?
N e u t ra l
9%
N o t im p o r t a n t
3%
V e ry im p o rt a n t
88%
Source: Ekos Research Associates, 2000.
Figure 2: Support for Universality
Currently, Canada’s system of medicare is supported by tax dollars. Do
you think governments should pay for health care for all people as they
do now, just for lower income people, or should individuals and families
pay their own health care costs?
S h o u ld p a y fo r lo w
in co m e p e o p le
o n ly
11%
In d iv id u a ls sh o u ld
p a y t h e ir o w n
3%
G o ve rnm e nt
sh o u ld p a y fo r a ll
p e o p le
86%
Source: Environics, 1999.
- 25 -
Canadians’ Thoughts on Their Health Care System
Figure 3: Evolution of Assessments of the Quality
of the Health Care System
"Thinking broadly about Canada's health-care system and the quality of medical
services it provides, how would you describe it overall? Would you say it is
excellent, very good, good, only fair, poor or very poor?"
E x c ellen t / v ery g o o d
G ood
F a ir/ p o o r/ v ery p o o r
70
61
60
55
50
41
40
30
10
31
30
29
25
20
40
41
38
32
32
30
28
34 34
29
21
13
12
15
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Source: Ipsos-Reid.
Figure 4: Is the American System Better?
When you think about Canada and the US, which country would you
say has a better health care system?
100%
91%
84%
80%
1987
60%
40%
2001
20%
3%
9%
4%
7%
0%
Canada
US
Don't know
Source: Environics, 1987; Centre for Research and Information on Canada, 2001.
- 26 -
Canadians’ Thoughts on Their Health Care System
Figure 5: Preference for Care in Canada Rather
than the U.S.
Do you agree or disagree with the following statement:
“If I had a serious illness or injury, I would prefer to be treated in the U.S.”
A g re e
S tr on g ly
3%
D K /N A
1%
A g re e
M od e ra te ly
4%
D isa g re e
M od e ra te ly
17%
D isa g re e
S tr on g ly
75%
DK/NA = don’t know/not applicable.
Source: Ipsos-Reid, September 1995.
Figure 6: Health Care and National Identity
How important are the following to the Canadian identity
… Canada’s health care system?
14%
3% 1%
V e ry im p o rta n t
S o m e w h a t im p o rta n t
N o t v e ry im p o rta n t
N o t a t a ll im p o rta n t
82%
Source: Environics Focus Canada Survey, March 1996.
- 27 -
Canadians’ Thoughts on Their Health Care System
Figure 7: Health Care Should be
Guaranteed by the Government
“Should medical care be guaranteed by the government?”
96%
1991
3%
Yes
95%
1985
No
4%
72%
1978
10%
0%
20%
40%
60%
80%
100%
Source: Environics Focus Canada Surveys.
Figure 8:
Support for the Canadian Health Care Model
Do you agree or disagree with the following statements?
P re fe r U S sy st e m
5 3 11
M e d ica re is rig h t o f cit iz e n sh ip
0%
20%
N e ith e r
Source: Earnscliffe/POLLARA, 1998.
- 28 -
40%
D is ag re e
9
4
12
79
pay
A g re e
8
63
C a re sh o u ld b e b a se d o n n e e d , n o t a b ilit y t o
19
20
52
B e t t e r ca re fo r rich is n o t rig h t
17
21
48
M e d ica re e m b o d ie s C a n a d ia n v a lu e s
C o m p le te ly a g re e
69
9
60%
80%
4 7
2 7
16
6 12
100%
C o m p le te ly d is ag re e
Canadians’ Thoughts on Their Health Care System
Figure 9:
Five Year Trend on Perceptions of Quality
Has the quality of health care over the past two years improved,
deteriorated, or stayed the same?
D e t e rio ra t ed
Sam e
I m p ro v e d
80
72
68
60
71
66
40
58
57
31
32
24
24
20
22
19
66
64
65
26
26
24
7
8
8
9
8
6
8
9
10
O ct.
'9 7
A p r.
'9 8
O ct.
'9 8
A p r.
'9 9
O ct.
'9 9
A p r.
'0 0
O ct.
'0 0
A p r.
'0 1
O ct.
'0 1
0
Source: Ekos Research Associates, Rethinking Government and Health Care Surveys.
Figure 10: Options for Reform
Health care costs are expected to rise in the future because of our aging population and because of the costs of new
treatments and medications. Which of the following statements comes closest to your view? Would you say (a) governments
should significantly INCREASE THEIR SPENDING on health care to cover these rising costs; (b) governments should LIMIT
THE AVAILABILITY of some treatments or medications; or (c) governments should allow THE PRIVATE SECTOR to provide
some health care services to those people who can afford to pay for them.
70
60
50
Canad a
62
60
56
54
47
48
51
Atlan tic
49
Qu eb ec
38
40
36
33
30
30
27
30
39
33
On tario
M an ito b a
Saskatch ewan
20
9
10
8
10
7 8
10
13
Alberta
9
BC
0
Increase Spending
Limit Services
Source: Centre for Research and Information on Canada, 2001.
- 29 -
Private Services
Canadians’ Thoughts on Their Health Care System
Figure 11:
Future Directions for the Health Care System
Which of the following three directions do you support for the future
of Saskatchewan’s health care system?
M o st p ro b le m s ca n
It is t im e t o m o v e
b e fix e d if t h e
p ro v in cia l
g o ve rn m e n t p u t s
m o re m o n e y in t o
t o w a rd p riva t e
N R /D K
h e a lt h ca re
12%
10%
h e a lt h
10%
C h a n g e s a re
ne e de d, but the
p rin cip le s o f
M e d ica re sh o u ld
b e p re se rve d .
68%
NR/DK = no response/don’t know.
Source: Saskatchewan Commission on Medicare, 2001.
Figure 12: Is More Money Alone the Answer?
“Money alone is not the solution to securing health care for the future.”
D isa g re e
14%
N e u t ra l
10%
A g re e
76%
Source: Ekos Research Associates, Ontario Health Care Funding Survey, 2000.
- 30 -
Canadians’ Thoughts on Their Health Care System
Figure 13:
Knowledge of the Canada Health Act
What are some of the key principles of the Canadian Health Act?
D o n ot kn ow
U n iv e r sa lity
C o m p r e h e n siv e n e ss
P o r ta b ility
68
TO TA L
21
65
M en
A c c e ssib ility
24
71
W o m en
8
13
19
74
A tla n tic
12
4
8
4
11
8
3
7
9
3
19
O n ta rio
71
20
11
6 4
S ask.
70
21
10
11 1
Quebec
68
M a n ito b a
67
18
62
B .C .
26
59
A lb e rta
14
23
12
7
9
3
11
4
7
31
19
2
8
7
Source: Earnscliffe/POLLARA, 1998.
Figure 14: Canadians’ Highest Priorities
H e a lt h C a re
U n e m p lo y m e n t
T he eco no m y
E d u c a tio n
60
51
50
42
40
10
0
22
18
10
40
40
36
33
30
20
45
32
21
21
31
29
23
0
0
0
1988
1990
1992
4
3
1993
1994
1996
23
18
15
12
8
28
20
17
39
13
13
8
1997
M a rc h
N ov.
98
98
1999
2000
Source: Ipsos-Reid: “Thinking of the issues presently confronting Canada, which one do you feel
should receive the greatest attention from Canada’s leaders?”
- 31 -
Canadians’ Thoughts on Their Health Care System
Figure 15: Images of the Future of Health Care
What will it look like 10 years from now?
39
M o re g o v e rn m e n t r o le
16
T h e r e w ill b e m o r e
40
68
o u t -o f- p o ck e t co st s
It w ill co st m o r e t o
11
19
81
m a in t a in
C a r e o u t sid e h o sp it a ls
7
82
w ill b e m o r e im p o rt a n t
M o re d e m a n d fo r
6
87
h e a lt h ca re se rv ice s
0%
20%
9
5
40%
A g re e
10
60%
N e ith e r
80%
7
100%
D is a g re e
Source: Ekos Research Associates, 1999.
Figure 16: Is Progress Being Made?
Is Canada making progress or losing ground on the health care
system?
70
60
50
59
54
49
40
28
30
14 16
20
32
25
12
10
4
4
4
0
L o s in g
g ro u n d
M a k in g
p ro g res s
N a tio n a l
S t a y in g t h e
sam e
M en
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
- 32 -
W om en
D K /N R
Canadians’ Thoughts on Their Health Care System
Figure 17: A Funding Crisis?
Do you think the Canadian health care system is facing a major funding
crisis? (For those who say “NO”: Will the system face a major funding
crisis in the next 5-10 years?)
N o crisis
W ill b e in crisis in
11%
NR /D K
1%
5 - 1 0 y e a rs
12%
In crisis n o w
76%
NR/DK = no response/don’t know.
Source: Ipsos-Reid, 2001
Figure 18: Satisfied with Medicare?
“Medicare in Canada works fine just the way it is.”
80%
60%
40%
37%
20%
0%
% A g re e
Source: Ipsos-Reid, 2000.
- 33 -
Canadians’ Thoughts on Their Health Care System
Figure 19: System in Crisis?
International Comparisons
On the whole, the health care system: 1) works pretty well and only minor changes are
necessary; 2) There are some good things in our health care system but fundamental changes
are needed; 3) Our health care system has so much wrong that we need to completely rebuild
it?
A u st r a lia '9 8
19
49
9
N e w Z e a la n d '9 8
30
57
U K '9 8
32
25
U K '8 8
58
27
U S '9 8
52
17
C a n a d a '9 8
17
46
10
U S '8 8
14
33
60
20
29
56
C a n a d a '8 8
23
56
0%
38
20%
W o rk in g p r e t t y w e ll
40%
60%
N e e d s m a jo r ch a n g e s
5
80%
100%
N e e d s t o b e co m p le t e ly r e b u ilt
Source: Commonwealth Fund International Health Policy Survey, 1998.
Figure 20: Federal/Provincial Satisfaction
Generally speaking, do you approve or disapprove of the current
federal/provincial government’s handling of health care?
F ederal
P r o vin c ia l
100
80
69
64
70
66
69
63
54
60
40
70
61
64
62
53
53
41
53
43
29
46
35
20
32
33
34
26
29
23
29
29
27
19
0
'8 5 '8 6 '8 7 '8 8 '8 9 '9 0 '9 1 '9 2 '9 3 '9 4 '9 5 '9 6 '9 7 '9 8 '9 9 '0 0 '0 1
Note: Percent responding “strongly approve” or “approve.”
Source: Environics Focus Canada Surveys.
- 34 -
Canadians’ Thoughts on Their Health Care System
Figure 21: Government Performance on
Health Care 1988-99
Is the federal/provincial government doing an excellent, good, fair or poor job of
ensuring that Canadians get good health care? (Percent saying excellent or good.)
80%
62%
60%
57%
56%
46%
58%
40%
57%
56%
46%
F e d e ra l
34%
P ro v in c ia l
30%
20%
0%
1988
1992
1993
1994
1999
Source: Berger Health Monitor.
Figure 22:
Who Is Responsible for Deterioration?
Which level of government is most responsible for the deterioration?
P ro v in c ia l
70
58
56
55
51
48
50
48
46
44
45
42
40
41
30
10
D K /NR
63
60
20
F ed era l
38
34
30
17
39
36
14
10
7
41
6
8
8
10
6
0
J an .
J u l.
J an .
J u l.
Jan.
J u l.
Jan.
J u l.
J an .
J u l.
'9 7
'9 7
'9 8
'9 8
'9 9
'9 9
'0 0
'0 0
'0 1
'0 1
Source: Ekos Research Associates, Rethinking Government, and Health Canada Surveys.
- 35 -
Canadians’ Thoughts on Their Health Care System
Figure 23: Quality of Care: 2000-01
Overall, how would you rate the quality of care you personally received
in the past twelve months (from the health care system)?
60%
45%
43%
37%
45%
35%
30%
M ay 2000
1 6 %1 5 %
15%
M a rc h 2 0 0 1
4% 5%
0%
E x c e lle n t
Good
F a ir
Poor
Note: Among respondents who used health services in the previous year.
Source: Berger Health Monitor, May 2000, March 2001.
Figure 24: Personal Experiences with the System
Agree or disagree: “My experience with the system was positive.”
TO TA L
58
20
W o m en
59
17
56
M en
58
B .C .
9
5
10
20
5
8
6
4
10
21
7
4
11
22
61
O n ta rio
5
10
5
8
Q uebec
56
M a n ito b a
56
23
9
5
7
A lb e rta
56
23
9
5
7
S ask.
15
43
26
C o m p le te ly a g r e e
A g ree
N e ith e r a g r e e n o r d isa g r e e
D isa g r e e
C o m p le te ly d isa g r e e
Source: Earnscliffe/POLLARA, 1998.
- 36 -
5
13
16
10
7
7
Canadians’ Thoughts on Their Health Care System
Figure 25: Confidence in Health Care Services
I am confident that if I or a family member were to become seriously
ill, we would be able to access the necessary health care services.
80%
60%
60%
40%
23%
16%
20%
0%
N o t C o n fid e n t
C o n fid e n t
N e ith e r
Source: Ekos Research Associates, Rethinking Government, January 2001.
Figure 26:
Inability to Access Health Care: 1989-2001
Over the last twelve months, were you ever unable to obtain health
care services when you needed them?
80%
60%
40%
20%
12%
15%
2%
0%
1989
2000
Note: Among respondents who used health services in the previous year.
Source: Berger Health Monitor, 1989, May 2000, March 2001.
- 37 -
2001
Canadians’ Thoughts on Their Health Care System
Figure 27: Inability to Access Health Care by
Province: 1989-2000
For those expressing difficulty obtaining health services in the previous
year: Had difficulty or did not eventually obtain services…
1989
N ATION AL
2000
12%
2%
A tla n tic
16%
1%
Q uebec
11%
3%
O n ta rio
1%
M a n ito b a , S a sk.
1%
A lb e rta
1%
B .C .
1%
0%
12%
14%
16%
11%
5%
10%
15%
20%
Note: 1989: “Had difficulty” and “did not receive services.” 2000: “Unable to obtain health services
when needed.”
Source: Berger Health Monitor.
Figure 28: Satisfaction with Care:
Own Family versus Province
Are you satisfied with the system’s ability to meet health care needs
of you and your family? Of all residents of your province?
80%
79%
59%
60%
38%
40%
20%
20%
0%
S e lf an d F am ily
A ll re sid e n ts o f p ro v in c e
V ery / so m e w h at satisfied
N o t v ery / n o t at all satisfie d
Sources: Merck Frost/Coalition of National Voluntary Organizations/POLLARA National Survey of
Health Care Providers and Users, 1999.
- 38 -
Canadians’ Thoughts on Their Health Care System
Figure 29:
Difficulty Obtaining Health Care: 1989-2000
In the past year have you or members of your immediate family had
difficulties obtaining medical or health-related services…
1989
N ATION AL
2000
34%
18%
A t la n t ic
43%
15%
Quebec
50%
24%
O n t a r io
25%
17%
M a n it o b a , S a s k .
14%
A lb e r t a
14%
B .C .
39%
31%
24%
18%
0%
10%
20%
30%
40%
50%
60%
Note: “Had difficulty,” “a bit, somewhat,” or “very difficult,” for a variety of reasons.
Source: Berger Health Monitor.
Figure 30: Difficulties in Seeing Specialists:
International Comparisons
Per cent who reported difficulties, 1998
57
60
47
50
40
30
30
20
56
55
54
24
16
15
21
19
14
17 18
10
10
0
C anada
U n ite d
A u stra lia
S ta te s
E x tre m e ly / v e ry d iffic u lt
U n ite d
N ew
K in g d o m
Z e a la n d
S o m e w h a t d iffic u lt
N o t to o / N o t a t a ll d iffic u lt
Source: Commonwealth Fund 1998 International Health Policy Survey.
- 39 -
Canadians’ Thoughts on Their Health Care System
Figure 31:
Concerns about Waiting Times
“My local hospital emergency room provides services in a
reasonable amount of time”
30%
Strongly agree
18%
Somewhat agree
Somewhat disagree
Strongly disagree
31%
18%
Source: Ipsos-Reid, 2000.
Figure 32: System Perform ance
How is the health system ’s perform ance on…
22
W a i t in g / E R
17
W a i t in g / s p e c i a l is t
M o r a le o f m e d ic a l s t a f f
11
L e n g t h o f h o s p it a l s t a y
10
W a it i n g / o p t i o n a l s u r g e r y
10
U s e b e s t a v a ila b le d r u g s
10
Poor
21
27
13
W a it in g / p r e s c r i b e d s u r g e r y
V ery p o o r
29
25
25
19
29
Good
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
- 40 -
22
6
7
6
28
V ery g o o d
3
9
23
32
16
7
27
34
4
7
23
27
21
7
21
26
23
A vera g e
18
14
D K /N R
3
5
12
5
Canadians’ Thoughts on Their Health Care System
Figure 33: Support for Equalization
As you may know, under the federal equalization program money is transferred from the
richer provinces to the poorer ones, in order to ensure that Canadians living in every
province have access to similar levels of public services. Do you strongly support,
moderately support, moderately oppose, or strongly oppose the equalization program?
80
55
50
45
41 42
38
48
32
44
40
37
41
40
45
39
34
0
N a t io n a l
A t la n t ic
Quebec
O n t a r io
S tro n g ly S u p p o rt
M a n it o b a
Sask.
A lb e r t a
BC
M o d e ra te ly S u p p o rt
Source: Centre for Research and Information on Canada, 2001.
Figure 34: Growing Empowerment
2000
1995
I a lw a y s a s k m y d o c to r q u e s tio n s
69%
a b o u t th e m e d ic in e h e / s h e p re s c rib e s
64%
me
I p re fe r w h e n m y d o c to r g iv e s m e
72%
d iffe re n t tre a tm e n t o p tio n s to c h o o s e
fro m ra th er th a n ju s t w ritin g o u t a
65%
p re s c rip tio n
0%
20%
Source: Ipsos-Reid Report.
- 41 -
40%
60%
80%
100%
Canadians’ Thoughts on Their Health Care System
Figure 35: Use of Health Related Internet Sites
In the past month, have you surfed or visited any Internet sites or looked up any
information regarding health, health information, health organizations, medical
conditions, medication, health products, alternative remedies, or anything having
to do with health and well being? (percent saying “yes”)
50%
40%
43%
39%
30%
20%
10%
0%
2000
2001
Source: Berger Health Monitor, May 2000, March 2001.
Figure 36: Discussions with Physicians
Regarding Internet Information
The last time you visited or consulted your doctor, did you take or refer
to information you had obtained over the Internet? (percent saying “yes”)
40%
30%
24%
20%
17%
10%
0%
1999
2001
Note: 1999: Asked only of those who had visited a health related site in the previous month, or had had
someone visit a site for them.
2000: Asked only of those who had visited a health related site in the previous month.
Source: Berger Health Monitor.
- 42 -
Canadians’ Thoughts on Their Health Care System
Figure 37: Communication with
Physicians by E-mail and Internet
Would you be interested in communicating with your doctor using e-mail
and the Internet, for example… (percent saying “yes”)
100%
80%
67%
63%
60%
52%
40%
20%
0%
A rra n g e
a p p o in t m e n t s
G e t in f o r m a t io n o n
y o u r h e a lt h c o n d it io n
D is c u s s y o u r
trea tm en t
Note: Among visitors to Internet health sites in previous month.
Source: Berger Health Monitor, March 2001.
Figure 38: Use of E-mail and Internet:
Sociodemographic Differences
Would you be interested in communicating with your doctor using e-mail
and the Internet, for example: 1. To arrange appointments. 2. To get
information on your health condition. 3. To discuss your treatment.
A v e ra g e "Y e s " t o t h re e o p t io n s
100%
80%
61%
67%
56%
60%
64%
55%
48%
40%
28%
20%
0%
V is ito rs
M en
W o m en
1 5 -1 9
5 5 -6 4
to h e a lth
s ite s
Note: Among visitors to Internet health site in previous month.
Source: Berger Health Monitor, March 2001.
- 43 -
6 5 -7 4
75+
Canadians’ Thoughts on Their Health Care System
Figure 39:
Health Related Purchases over the Internet
In the past month have you bought anything over the Internet that was related to
health, for example…
2000
2001
20%
15%
13%
10%
7%
5%
5%
5%
1%
1%
3%
2%
1%
3%
1%
1%
0
0%
2%
B o o k s,
O rg a n ic
N a t u ra l
Ove r the
P re scrip t io n
M e d ica l,
m a g a z in e s
fo o d s
h e a lt h
co u n t e r,
m e d ica t io n
o t h e r h e a lt h
p ro d u ct s
non-
O n e o r m o re
co n su lt a t io n
p re scrip t io n
m e d ica t io n
Note: Among visitors to Internet health site in previous month. Percent saying they had made such a
purchase in the previous month.
Source: Berger Health Monitor, March 2001.
Figure 40: Use of Natural Health Products
In the past six months, have you taken any of the following…
M a rc h '9 9
M a y '0 0
M a rc h '0 1
80
70
72
75
60 60 61
60
38
36 36 36
40
33
28
20
15 14
19
26
16
14 15
28
31
15
1
1
0
V ita m ins
M i ne r a l
F ood
H o m e o pa thic
H e r ba l
s up pl e m e nts
s upp le me nts
remedies
r e me di e s
Source: Berger Health Monitor.
- 44 -
O the r s
1 + i te ms
3 + i te ms
Canadians’ Thoughts on Their Health Care System
Figure 41: Use of Alternative Health Providers
In the past six months, have you used any of the following services…
40%
30%
24%
20%
12%
10%
10%
3%
3%
2%
1%
2%
2%
1%
1%
3%
1%
M
re
re
T
h
n
e
e
o
o
r
r
m
m
o
o
re
t
is
g
lo
o
id
O
i
k
ie
R
Ir
e
th
e
th
ch
u
o
T
t
p
ra
p
ra
lo
o
x
e
fl
e
R
is
t
is
t
is
g
a
p
e
m
o
H
n
u
p
cu
C
a
h
A
o
cu
d
e
m
se
e
in
th
t
is
tr
in
ic
a
rb
e
p
ss
e
st
li
th
a
H
ro
tu
a
N
a
C
g
e
h
ir
th
o
e
p
ra
ra
p
ct
is
o
t
r
0%
Source: Berger Health Monitor, 1999.
Figure 42:
Use of Natural Health Products by Region
Percentage reporting using three or more natural health products
in the previous six months.
60%
41%
40%
34%
33%
30%
27%
20%
15%
0%
A t la n t ic
Que be c
O n t a rio
M a n it o b a ,
S a sk .
Source: Berger Health Monitor, March 2001.
- 45 -
A lb e rt a
B .C .
Canadians’ Thoughts on Their Health Care System
Figure 43: Health Information on the Internet
The last time you used the Internet for health-related information, would
you say you were looking for…
60%
56%
50%
40%
30%
19%
18%
20%
8%
10%
0%
M a in stre a m
A lte rn a tiv e
in fo rm a tio n
in fo rm a tio n
B o th
N ot
lo o k in g / D K
DK = don’t know.
Note: Among direct and indirect Internet users for health related purposes.
Source: Berger Health Monitor.
Figure 44: Use of the Internet: Which Sites?
The last time you used the Internet for health-related purposes did you
visit any of the following health-related sites:
M a y -0 0
M a r-0 1
50%
44%
40%
30%
20%
33%
28%
24%
16%
10%
18%
16%
7%
7%
0%
H ea lth
C an a d ian
P ro v in c ia l
C anada O n-
H ea lth
g o v t, h e alth
lin e
N etw o rk
m in is try
U n iv e rs ity
D is e as e ,
c o n d itio n s ite
Note: Internet users who visited a health-related site in previous month, or had someone look for them
in past six months.
Source: Berger Health Monitor, May 2000, March 2001.
- 46 -
Canadians’ Thoughts on Their Health Care System
Figure 45: Support for the Principles of the Canada
Health Act: 1991-99
The Canadian health care system is based on five principles developed some years
ago. Please tell me how important you think it is to keep each of these five
principles… (detailed explanation of each principle provided in question).
U n iv ers a lit y
A c c es s ib ilit y
P o rt a b ilit y
C o m p re h en s iv en es s
P u b lic A d m in is t ra t io n
100
93
89
90
89
85
89
85
88
80
78
81
79
80
80
78
76
70
76
73
60
63
64
59
56
50
1991
1994
1995
1999
2000
Note: Per cent answering “very important” (3 other response choices: “somewhat important,”
“not very important,” and “not at all important”.
Source: Berger Health Monitor.
Figure 46: Entirely Public or Some Private?
In your opinion, should Canada allow privately-owned companies to
deliver some health care services in Canada, or should the health care
system be operated entirely as a public program?
80
74
NATIONAL
66
60
60
51
47
40
45
36
24
58 57
44
39 41
Atlantic
Quebec
Ontario
29
M an / Sask
20
Alberta
0
BC
Allow Private
Entirely Public
Source: Centre for Research and Information on Canada, Environics/CROP, 2000.
- 47 -
Canadians’ Thoughts on Their Health Care System
Figure 47: Support for Some Private Care:
2000-2001
In your opinion, should Canada allow privately-owned companies to deliver some
health care services in Canada, or should the health care system be operated
entirely as a public program?
60
47
50
40
51
45
42
36
34
48
42
39 40
41
34
29
30
2000
24
2001
20
10
0
Canada
A tla n tic
Quebec
O n ta rio
Man /
Sask
A lb e rta
BC
Source: Centre for Research and Information on Canada.
Figure 48: Opposition to Funding Cuts
1989-1999: Some people think that the federal government should cut back its spending in
some areas while other people disagree. Could you tell me whether you support the
following measures… cutting back federal funds for health care.
2001: Keeping in mind that increasing services could increase taxes, do you think the
federal government is spending too much, just the right amount, or is spending too little on
each of the following?
90%
78%
S u p p o rt c u ttin g
s p e n d in g / w e 'r e
s p e n d in g t o o m u c h
R ig h t a m o u n t
18%
12%
5%
S p e n d in g to o little
5%
4%
0%
1989
1995
1999
Source: Environics Focus Canada Surveys.
- 48 -
2001
Canadians’ Thoughts on Their Health Care System
Figure 49: Coverage of Public Health Care
Does Canada’s public health care system cover enough services
and programs?
60%
47%
50%
42%
40%
30%
20%
10%
9%
0%
C o v e rs to o m u c h
A b o u t r ig h t
D o e sn 't c o v e r
enough
Source: Ipsos-Reid, The Public Domain, May 2000.
Figure 50:
Restore Funding or New Programs: 1996
One of the areas for which the government may announce some new spending is health
care. Now, in your view, which of the following should be the government’s first priority:
1. Restoring to the provinces the funding intended for Medicare that was cut by the
federal government to help reduce the deficit; or 2. Funding new national healthcare
programs such as a new pharmacare program or a new homecare program?
R e sto re
7 0 .9 %
F u n d in g
N e w P ro g ra m s
2 6 .8 %
0%
20%
40%
Source: Ipsos-Reid, March 1996.
- 49 -
60%
80%
Canadians’ Thoughts on Their Health Care System
Figure 51: Quality vs. Equal Access
Which of the following aspects of health care is of greatest
importance to you?
Q u a lity
60%
A c c e ss
53%
50%
45%
41%
43%
43%
40%
40%
30%
31%
33%
20%
10%
0%
1995
1997
1998
2000
Source: Ekos Research Associates, Health Issues Tracking Survey.
Figure 52: Equal Access vs. Quality of Care
Do you agree/disagree with each of the following?
M a in t a in eq u a l a c c es s ev en if w e
c a n 't h a v e h ig h es t lev el o f c a re
44
W e n eed o n e s y s t em w it h eq u a l
a c ce s s ev en if it c o s t s m o re
20
68
0%
17
50%
C o m p le te ly a g r e e
A g re e
N e ith e r a g r e e n o r d isa g r e e
D isa g r e e
C o m p le te ly d isa g r e e
DK/NR
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
- 50 -
16
8 11
9 33
100%
Canadians’ Thoughts on Their Health Care System
Figure 53: Where Should the Money Come
From? (Saskatchewan)
If more money is required for the health care system, where do you
believe this extra money should come from?
In c re a s e d ta xe s
21%
N o re s p o n s e
41%
C u ts to o th er
p ro g ra m s
9%
In d iv id u a ls p a y
29%
Source: Saskatchewan Commission on Medicare, 2001.
Figure 54: Where Should the Money
Come From? (National)
R e d u c e a c c e s s o r q u a lity o f h e a lth c a re
22%
33%
In c re a s e ta xe s
40%
T a k e m o n e y fro m o th e r s o c ia l p ro g ram s
H a v e th o s e w h o c a n a ffo rd to p a y s o m e
70%
o f th eir h e a lth c a re c o s ts
T a k e m o n e y fro m o th e r n o n -s o c ia l
71%
p ro g ra m s
0%
Source: Merck Frost/Pollara, 1999.
- 51 -
20%
40%
60%
80%
Canadians’ Thoughts on Their Health Care System
Figure 55: Tracking Privatization
Which statement is closer to your own view?
O nce priv a te he a lth ca re s e rv ice s s ta rt to b e co m e w id e ly a v a ila b le , it
w o n't b e lo ng be fo re qua lity p ub lic he a lth ca re s e rv ice s a re ha rd to find .
Allo w ing s o m e p riv a tiz a tio n o f the he a lth ca re s y s te m is a go o d thing
be ca us e it w ill re lie v e the p re s s ure o n p ub lic ins titutio ns lik e ho s pita ls
tha t a re a lre a d y o v e rcro w d e d.
A ug . '0 1
67
31
D e c. '9 9
68
28
M a r. '9 9
71
26
0
20
40
60
80
Source: Ekos Research, Rethinking Government Surveys.
Figure 56: Opposition to Privatization
In some provinces, there is talk of allowing private health clinics to charge patients a fee for
using the facility and also receive the usual payment from the province for performing a
particular operation. Some people say these clinics are a good way to deal with health care
cutbacks and waiting lists by allowing some people to pay for a health service. Others say
that this development, if it continues, will erode Canada’s universal health care system.
Which of these views is closer to your own?
100
80
64
60
31
40
20
4
0
G o o d w a y to d e a l
W ill e ro d e th e
w ith fu n d in g c u ts
h e a lth c a re sy ste m
a n d w a itin g lists
Source: Environics, 2000.
- 52 -
D o n 't k n o w
Canadians’ Thoughts on Their Health Care System
Figure 57:
Opposition to a Mixed Public/Private System
Do you personally support or oppose moving more money towards [a two-tiered
system/a mixed public-private system] where people are free to pay for faster or
better health care services.
60 %
55 %
50 %
33%
S u p p o rt
2 9%
O ppose
N e ith er
1 7%
16 %
0%
A T w o -T ie red S y s tem
A M ixed P u b lic / Priv ate S y s tem
Source: Ekos Research, Benchmark Survey, August 1999.
Figure 58: Some Support for Two-Tiered?
“It is alright if Canada’s health care system evolves into a two-tier system
where privately owned and public health institutions offer all health services.”
50%
38%
40%
28%
30%
S t ro n g ly a g ree
S o m ew h a t a g ree
20%
S o m ew h a t d is a g ree
19%
S t ro n g ly d is a g ree
14%
10%
0%
A c c ep t a b le if t h ere is t w o -t iered
Source: Ipsos-Reid, 2000.
- 53 -
Canadians’ Thoughts on Their Health Care System
Figure 59:
Paying for Quicker Access? 1996-2001
Individuals should be allowed to pay extra to get quicker
access to health care services.
A g re e
D isa g re e
80%
67%
61%
60%
55%
54%
34%
35%
52%
40%
36%
29%
20%
23%
0%
N o v . '9 6
N o v . '9 7
M a r '9 9
D e c . '9 9
Ja n . '0 1
Source: Ekos Research Associates, Rethinking Government Surveys.
Figure 60: Paying for Quicker Access?
Regional Breakdown
Individuals should be allowed to pay extra to get quicker
access to health care services.
N a tio n a l
36
11
52
BC
42
12
AB
44
7
36
M B/SK
ONT
33
QC
36
ATL
35
0%
20%
44
49
15
48
11
56
12
51
11
53
40%
A g re e
60%
N eith e r
D is a g ree
Source: Ekos Research Associates, Rethinking Government, January 2001.
- 54 -
80%
100%
Canadians’ Thoughts on Their Health Care System
Figure 61: Paying for Quicker Care?
Do you agree with people paying extra for quicker care?
60%
49%
50%
40%
30%
20%
15%
13%
12%
N e ith e r a g re e
D is ag re e
9%
10%
0%
C o m p le te ly
A g re e
ag re e
C o m p le te ly
n o r d is a g re e
d is ag re e
Source: Earnscliffe/POLLARA, 1998.
Figure 62: Paying to Get to the Head of the Line?
1996: Would you approve of an arrangement where people could pay to wait a
shorter time for health care services?
1999: Would you approve of a provincial health system where people could pay to go
to the head of the line for health care services?
S t ro n g ly d is a p p ro v e, '9 9
S t ro n g ly d is a p p ro v e, '9 6
S t ro n g ly a p p ro v e, '9 9
S t ro n g ly a p p ro v e, '9 6
80
70
67
60
50
49
44
40
30
10
27
21
18
5
46
41
38
20
67
66
61
50
46
68
67
64
13
4
7
14
13
5
4
7
13
5
0
N A T IO N A L
B .C .
A lb e rt a
M a n , S a sk
Source: Berger Health Monitor.
- 55 -
O n t a rio
Que be c
A t la n t ic
Canadians’ Thoughts on Their Health Care System
Figure 63: Perception of Treatment in
Private System
“You and your family would be treated fairly in a system where people
could pay to get to the front of the line.”
S t ro n g ly a g ree
S t ro n g ly d is a g re e
80
56
52
51
51
46
50
40
8
14
9
7
7
10
0
B .C .
A lb e rta
M an , S a s k
O n ta rio
Q uebec
A tla n tic
Source: Berger Health Monitor, 1999.
Figure 64: Paying for Timely Access?
100%
98%
73%
A g re e
50%
D is a g re e
27%
2%
0%
"A ll C a n a d ia n s s h o u ld
rec e iv e t im ely a c c es s "
"C a n a d ia n s w it h o u t
t im e ly a c c e s s s h o u ld h a v e
o p t io n o f u s in g p riv a t e
fa c ilit y "
Source: Merck Frost/Pollara, 1999.
- 56 -
Canadians’ Thoughts on Their Health Care System
Figure 65: Attitudes toward “Bill 11” Model
The provincial government in Alberta recently announced its intention to allow
privately owned health institutions to offer services like hip replacements and
they will be paid by the government with taxpayers’ dollars. From what you
know, would you support or oppose the proposal put forward by Premier Klein?
50%
40%
35%
30%
26%
21%
20%
15%
10%
3%
0%
S tro n g ly
S o m e w h at
So m ew hat
S tro n g ly
s u p p o rt
s u p p o rt
oppose
oppose
D o n 't kn o w
Source: Ipsos-Reid, April 2000.
Figure 66: Attitudes toward Bill 11
The provincial government in Alberta recently announced its intention to allow regional health
authorities to contract with private health care providers to provide some surgical services.
The Government of Alberta’s intent is to have these private providers operate under the
jurisdiction of a regional health authority and that under this arrangement these private
providers will be paid by the government and not by individual Albertans. From what you
know, would you say…
50%
39%
40%
27%
30%
18%
20%
11%
10%
6%
0%
S tro n g ly
S o m ew hat
So m ew hat
S tro n g ly
s u p p o rt
s u p p o rt
oppose
oppose
Source: Ipsos-Reid, April 1999.
- 57 -
D o n 't kn o w
Canadians’ Thoughts on Their Health Care System
Figure 67: Arguments in Opposition to Bill 11
T h is d e cis io n u n d e r m in e s u n iv e r s a lit y a n d t h e
p r in cip le t h a t a cc e s s t o h e a lt h ca r e in C a n a d a
41%
30%
is b a s e d o n m e d ica l n e e d , n o t a b ilit y t o p a y
D e cis io n s lik e t h is p u t C a n a d a o n e s t e p clo s e r
40%
t o h a v in g a n A m e r ica n s t y le h e a lt h ca r e s y s t e m
D e c is io n s lik e t h is m o v e C a n a d a o n e s t e p
25%
38%
clo s e r t o a t w o t ie r h e a lt h ca r e s y s t e m
28%
0%
V e ry e ffe c t iv e a rg u m e n t
50%
100%
S o m e w h a t e ffe c t iv e
Source: Ipsos-Reid, 1999.
Figure 68: Arguments in Opposition to Bill 11 #2
P riv a t e h e a lt h in st it u t io n s t h a t re ce iv e p u b lic
fu n d in g sh o u ld h a v e t o o p e n t h e ir fin a n cia l
71%
b o o k s t o p u b lic scru t in y t h e sa m e w a y t h a t
19%
p u b lic h o sp it a ls d o
T h e g o v e rn m e n t o f C a n a d a h a s a sig n ifica n t
ro le t o p la y in e n su rin g t h e g o v e rn m e n t o f
58%
A lb e rt a 's a ct io n s a re co n sist e n t w it h t h e in t e n t
29%
a n d sp irit o f t h e C H A
P u b lic fu n d s a re b e t t e r sp e n t o n im p ro v in g t h e
p u b lic sy st e m ra t h e r t h a n cre a t in g a p a ra lle l
34%
37%
p r iv a t e h e a lt h ca re se ct o r
0%
S tro n g ly a g re e
50%
S o m e w h a t a g re e
Source: Ipsos-Reid, 1999.
- 58 -
100%
Canadians’ Thoughts on Their Health Care System
Figure 69: Arguments in Support of Bill 11
P a y in g t h e p riv a t e sy st e m w it h p u b lic fu n d s
w ill r e d u ce t h e co st s t o t a x p a y e r s b e ca u se t h e
g o v e r n m e n t w ill n o t h a v e t o p a y t o b u ild n e w
16%
36%
fa cilit ie s. A s a r e su lt m o r e m o n e y w ill g o
t o w a rd t h e p r o v isio n o f se rv ice s
D e cisio n s lik e t h is a re n e ce ssa ry b e ca u se t h e
cu rre n t p u b lic sy st e m is n o t a b le t o m e e t t h e
25%
37%
risin g d e m a n d
P a y in g t h e p riv a t e sy st e m w it h p u b lic fu n d s
25%
w ill im p ro v e se rv ice s a n d re d u ce w a it in g t im e s
42%
0%
50%
V e ry e ffe c tiv e a rg u m e n t
100%
S o m e w h at e ffe c tiv e
Source: Ipsos-Reid, 1999.
Figure 70: Arguments in Support of Bill 11 #2
T h is is a n A lb e rt a issu e t o b e so lve d b y
A lb e rt a n s a n d a n y in t e rv e n t io n b y t h e
19%
19%
G o ve rn m e n t o f C a n a d a is in a p p ro p ria t e
It 's a ll rig h t if C a n a d a 's h e a lt h ca re sy st e m
e vo lve s in t o a t w o -t ie r sy st e m w h e re p riv a t e
a n d p u b ic h e a lt h in st it u t io n s o ffe r a ll h e a lt h
31%
17%
se rv ice s
A n yt h in g t h a t ca n b e d o n e t o im p ro v e h e a lt h
ca re se rvice s a n d re d u ce w a it in g t im e s in
30%
41%
C a n a d a sh o u ld b e d o n e , in clu d in g p a y in g
p riva t e fa cilit ie s t o p ro vid e ce rt a in h e a lt h ca re
se rv ice s
0%
S tro n g ly a g re e
50%
S o m e w h at ag re e
Source: Ipsos-Reid, 1999.
- 59 -
100%
Canadians’ Thoughts on Their Health Care System
Figure 71:
Arguments in Opposition to Privatization
U n iv e r sa l p u b licly - fu n d e d h e a lt h ca re is p a r t o f
w h a t it m e a n s t o b e C a n a d ia n a n d re fle ct s o u r
72%
co r e v a lu e s ; w e w o u ld b e a p o o re r s o cie t y if w e
sh ift e d t o a 2 t ie r h e a lt h ca r e s y s t e m
A llo w in g p e o p le t o p a y fo r fa s t e r o r b e t t e r
h e a lt h ca re se r v ice s w ill n o t b e n e ce ss a ry if
77%
g o v e r n m e n t s m a k e t h e r ig h t d e cis io n s t o d a y
a b o u t h o w t o m a k e t h e sy s t e m m o r e e fficie n t
T h e o n ly o n e s w h o w o u ld b e n e fit fr o m a llo w in g
78%
p e o p le t o p a y fo r fa s t e r o r b e t t e r h e a lt h ca r e
se r v ice s w o u ld b e w e a lt h y C a n a d ia n s
0%
50%
100%
A g re e
Source: Ekos Research Associates, 1999. Arguments introduced with: “Some people talk about the need
to allow Canadians to buy quicker or higher quality care than what is offered by the publiclyfunded health care system.”
Figure 72:
Arguments in Support of Privatization
A llo w in g p e o p le t o p a y fo r fa st e r o r b e t t e r
h e a lt h ca re se rv ice s is fa ire r b e ca u se it a llo w s
t h e fr e e d o m t o ch o o se a s is t h e ca se in o t h e r
40%
a r e a s o f t h e e co n o m y
It m a k e s n o se n se fo r g o ve r n m e n t s t o t ry t o
k e e p u p w it h t h e r isin g co st o f t h e p u b lic
h e a lt h ca re sy st e m b e ca u se t h e sy st e m is so
41%
d e m a n d in g t h a t it w ill a b so r b a n y a m o u n t o f
m o n e y p u t in t o it
B y h a v in g C a n a d ia n s p a y t o u se p riva t e clin ics,
56%
w a it in g t im e s in p u b licly - fu n d e d clin ics a n d
h o sp it a ls w o u ld b e re d u ce d
0%
50%
100%
A g re e
Source: Ekos Research Associates, 1999. Arguments introduced with: “Some people talk about the need
to allow Canadians to buy quicker or higher quality care than what is offered by the publiclyfunded health care system.”
- 60 -
Canadians’ Thoughts on Their Health Care System
Figure 73: User Fees
Thinking about the hospitals and your family use, do you agree that hospitals
must charge because there is not enough money anymore? (percent saying
“yes”)
58%
46%
46%
N A T IO N A L
A tla n t ic
Q uebec
47%
48%
M an/Sask
A lb e rta
44%
O n ta rio
44%
B .C .
Source: Berger Health Monitor, 1995.
Figure 74: Options for Raising Funds
Keeping in mind that right now all Canadians are entitled to necessary health
services without charge, if your provincial government had to increase its
health care budget, please tell me if you would strongly approve, somewhat
approve, somewhat disapprove or strongly disapprove of these ways to raise
money to pay for health care costs?
U s e r fe e s if p e o p le u s e
56%
m o r e t h a n a c e r t a in
a m ount
R a is e t a x e s
P h y s icia n s e x t r a b ill
31%
29%
42%
H o s p it a l u s e r fe e s
Note: Percentage “strongly” and “somewhat” approving combined and presented.
Source: Berger Health Monitor. 1995
- 61 -
Canadians’ Thoughts on Their Health Care System
Figure 75: Deep Support for User Fees?
If you found that user fees discouraged sick people from getting the
health services they needed, which of the following approaches
would you choose for these people?
G o v e r n m e n t s h o u ld p a y ,
49%
w h ic h m a y r e q u ir e
h ig h e r t a x e s
Y o u a n d t h e co m m u n it y
27%
w o u l d h e lp p e o p le p a y
P e o p le w o u ld fin d a w a y
15%
t o p a y fo r s e r v ic e s t h e y
r e a lly n e e d
Source: Berger Health Monitor, 1995.
Figure 76:
How Good an Idea Is Each of the Following?
P h a rm a c a re
20
P ro v id e m o n ey t o p o o r
47
24
In c rea s e p ro v in c ia l t ra n s fers
30
52
29
22
54
14
R es ea rc h
32
60
7
H o m e c a re
34
56
9
T a x b re a k s fo r t h e p o o r
41
0%
51
20%
40%
60%
7
80%
100%
O n e o f t h e b es t id e a s
A g o o d id ea b u t n o t t h e b es t
N o t a g o o d id ea
D K /N R
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
- 62 -
Canadians’ Thoughts on Their Health Care System
Figure 77: Canadians Giving Informal Care
Are you giving care to anyone in or out of your home, a child or
adult who needs care, attention, errands done for them or similar
kinds of help?
Y e s , c a re g iv in g …
2000
25%
1998
17%
1991
16%
0%
5%
10%
15%
20%
25%
30%
Source: Berger Health Monitor, May 2000.
Figure 78:
The Financial Burden of Informal Care
Among those providing informal care: Would you say that in helping
out as you do, you have to…
M a ke m a jo r c u ts to
22%
p e rs o n a l s p e n d in g
M a ke s o m e c u ts to
42%
p e rs o n a l s p e n d in g
32%
U s e s a v in g s
13%
B o rro w
56%
O n e o r m o re
33%
T w o o r m o re
0%
10%
20%
Source: Berger Health Monitor, May 2000.
- 63 -
30%
40%
50%
60%
Canadians’ Thoughts on Their Health Care System
Figure 79: General Support for Pharmacare
Among all the countries with national insurance programs, Canada is the
only one that does not include prescription drugs as part of its national
health care system. Do you believe Canada should leave the situation as it
is or should it include prescription drugs?
L e a v e s it u a t io n
27%
a s it is
0%
10%
20%
30%
40%
50%
Source: Berger Health Monitor, August 1998.
Figure 80:
Pharmacare: What Drugs to Include?
Keeping in mind that the more drugs that are included, the more expensive
the program will be – if governments expanded the coverage for prescription
drugs, should this increased coverage include…
O n ly d ru g s fo r
57%
se rio u s illn e ss
A ll d ru g s
39%
p re sc rib e d b y
d o c to r
0%
40%
Source: Berger Health Monitor, August 1988.
- 64 -
80%
Canadians’ Thoughts on Their Health Care System
Figure 81:
Support for Primary Health Service Teams
Delivering care through Primary Health Service Teams (PHST’s) is another idea for
everyday health care. These teams would include nurse practitioners, physicians,
nutritionists, pharmacists, therapists and others working together. Some team members
could serve more than one community. Services would be on call 24 hours a day, seven
days a week. In general, do you think the PHST approach would be positive or negative for
the quality of health services you receive?
60%
50%
49%
40%
P o sitiv e
N e g a tiv e
30%
24%
20%
14%
U n su re
13%
N o R e sp o n se
10%
0%
Source: Saskatchewan Commission on Medicare, 2001.
Figure 82:
Doctors or Specialized Professionals?
If you were in need of routine health care services, such as ear or throat infections,
managing diabetes, or monitoring high blood pressure, would you want to visit a
doctor, or would you be satisfied with seeing a general or specialized nurse who works
with a doctor?
60%
54%
50%
40%
30%
25%
20%
20%
10%
0%
S a t is fie d
N e u t ra l
Source: Ekos Research Associates, 2000.
- 65 -
N o t s a t is fie d
Canadians’ Thoughts on Their Health Care System
Figure 83: Support for Team Practices
For the health care needs of you and your family, would you prefer a family
doctor working as part of a team, or a family doctor practicing on his/her
own?
90%
80%
74%
70%
60%
50%
40%
24%
30%
20%
10%
3%
0%
P a rt o f a te a m
O n h is / h e r o w n
D o n 't kn o w
Source: Ekos Research Associates, 1999.
Figure 84:
Importance of Keeping Hospitals Open
Below are two different views about how to make sure that people get
everyday health services when they need them: 1. We should keep hospitals
open in as many communities as we can; 2. We could have fewer hospitals
if there were more ambulances and more trained ambulance staff available,
and people could get hospital care in larger centres when needed.
60%
51%
40%
32%
17%
20%
0%
K e e p H o s p it a ls
F e w e r H o s p it a ls
Source: Saskatchewan Commission on Medicare, 2001.
- 66 -
N o R e sp on se
Canadians’ Thoughts on Their Health Care System
Figure 85: Hospitals or Community Care?
If you were responsible for improving the health care system in Canada,
which of the following would you put more emphasis on?
60%
51%
40%
32%
17%
20%
0%
In v e s tin g m o re in th e
In v e s tin g m o re in n e w
B o th e q u a lly
c u rre n t s y s te m o f
a p p ro a c h e s s u c h a s
( v o lu n t e e re d )
d o c t o rs a n d h o s p it a ls
h o m e c a re , c o m m u n ity b a s e d c a re a n d e a rly
p re v e n t io n p ro g ra m s
Source: Ekos Research Associates, 1999.
Figure 86:
Options for Hospital Restructuring
Thinking about hospitals you and your family use, please tell me whether you
would strongly agree, somewhat agree, somewhat disagree or strongly
disagree with the following reasons for changing the way these hospitals
provide services to the public?
H o s p it a ls w h ich p r o v id e
82%
sa m e s e r v ice s sh o u ld b e
co m b in e d
C o m b in e d se r v ice m e a n s
73%
b e t t e r q u a lit y
T r a v e llin g 2 0 m in u t e s
52%
d o e sn 't h u r t p a t ie n t s
P a t ie n t s w o n 't r e ce iv e
sa m e a t t e n t io n if
35%
h o sp it a ls co m b in e d
Note: Percent “strongly” and “somewhat” agreeing combined and presented.
Source: Berger Health Monitor, 1995.
- 67 -
Canadians’ Thoughts on Their Health Care System
Figure 87: How Important Should Each of the
Following Goals Be for the Health Care System?
Percentage saying the goal should be “very important.”
75%
64%
62%
60%
50%
33%
25%
0%
E n h a n c e th e
P ro m o te h e alth
R e d u c e d is ab ility
q u a lity o f life
a n d w e lln e s s
a n d in c re a s e
P ro v id e life e xte n d in g
a b ility to
tre atm e n ts
fu n c tio n
Source: Merck Frost/Pollara, 1999.
Figure 88: Physician Assisted Suicide
“There are some circumstances under which physicians should
definitely be free to help patients commit suicide.”
D is a g re e
S tro n g ly
DK/N A
4%
A g re e S tro n g ly
24%
35%
D is a g re e
M o d e ra te ly
9%
A g re e
M o d e ra te ly
28%
DK/NA = don’t know/not applicable.
Source: Ipsos-Reid, September 1995.
- 68 -
Canadians’ Thoughts on Their Health Care System
Figure 89:
Treating Disease or Promoting Health?
Is it the job of the health care system to…
80%
59%
60%
40%
29%
20%
11%
0%
F o cu s o n ly o n t h e t r e a t m e n t
D o m o r e t h a n t re a t d ise a se ,
o f d ise a se , illn e ss a n d in ju ry
illn e ss a n d in ju ry , a n d a lso
D K/NA
p r o m o t e h e a lt h t h r o u g h
t h in g s lik e im p r o ve d
p a r e n t in g sk ills, b e t t e r
n u t rit io n a n d h e lp in g p e o p le
q u it sm o k in g
DK/NA = don’t know/not applicable.
Source: Saskatchewan Commission on Medicare, 2001.
Figure 90: Short-Term Policy Options
P a y in g d o c to rs e x tra in ru ra l
a re a s
R u ra l a m b u la n c e s e rv ic e
31
32
40
17
33
7 12
18
E R q u ic k re s p o n s e te a m s
45
33
C h a rt e r o f R ig h t s fo r h e a lt h c a re
47
27
T e le m e d ic in e
48
35
12 44
17
44
C o m p le te ly
s u p p o rt
S u p p o rt
N e ith e r
O ppose
M o re e q u ip m e n t
34
54
1 3 22
31
9 32
C o m p le te ly
oppose
DK/N R
G u a ra n te e o n w a itin g
60
0%
27
50%
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
- 69 -
8 22
100%
Canadians’ Thoughts on Their Health Care System
Figure 91: Importance of Various Goals
P r e d ia lo g u e
P o s t d ia lo g u e
1 .9 3
2 .2 3
G o v e rn m e n t s c o v e r t h e c o s t o f p re s c rip t io n d ru g s
1 .9 6
I n c re a s e d p e rf o rm a n c e re p o rt in g t o t h e p u b lic
E x p a n d e d u s e o f h e a lt h in f o rm a t io n t e c h n o lo g y
2 .5 4
2 .4
2 .8 8
3 .1 8
3 .0 8
I n c re a s e d h e a lt h p ro m o t io n
5 .1 3
5 .5 7
B e t t e r p a t ie n t a c c e s s t o m o d e rn m e d ic a l t e c h n o lo g y
A v a ila b le 2 4 -h o u rs a d a y , 7 d a y s a w e e k
5 .6 7
5 .7 8
I m p ro v e d a c c e s s t o m e d ic a l s p e c ia lis t s
5 .7 8
5 .7 2
E x p a n d e d h o m e a n d c o m m u n it y c a re s e rv ic e s
5 .8 3
5 .7 7
E x p a n d e d s u p p o rt f o r c o m m u n it y h e a lt h c lin ic s
6 .0 1
5 .5 1
A d e q u a t e n u m b e rs o f n u rs e s , d o c t o rs , s p e c ia lis t s a c ro s s t h e
6 .4 4
6 .4 4
c o u n t ry
0
1
2
3
4
5
6
7
Note: Respondents were asked to rank each goal in order of importance. Score of 10 indicates
“most important.”
Source: Ekos Research Associates, 2000.
Figure 92: Preferences for Spending
If you were Prime Minister for a day and had an additional $1 billion to invest in
health care, which would be in the best interest of the public?
70%
Im p ro ve d a cce ss t o fa m ily d o ct o rs a n d n u rse s
61%
U p g ra d in g a n d m o d e rn iz in g h o sp it a ls
58%
E x p a n d e d h o m e a n d co m m u n it y ca re p ro g ra m s
50%
In cre a se t h e a va ila b ilit y o f m o d e rn t e ch n o lo g y
In cre a se d r e p o rt in g o n t h e p e r fo rm a n ce o f t h e
47%
h e a lt h ca re sy st e m
32%
M a k in g b e t t e r u se o f in fo rm a t io n t e ch n o lo g y
25%
In cre a se d h e a lt h p r o m o t io n a ct iv it ie s
Source: Ekos Research Associates, 2000. Responses presented in a series of random pair choices.
- 70 -
Canadians’ Thoughts on Their Health Care System
Figure 93: Causes of Inefficiency
What are the leading causes of inefficiency in Canada’s health care
system?
D o c to r s p r e s c r ib e u n n e c e s s a r ily
64
52
55
H o s p ita ls d o n 't m a n a g e f in a n c e s w e ll
63
73
72
70
69
87
84
84
P e o p le u s e u n n e c e s s a r y s e r v ic e s
74
65
P e o p le in h o s p ita l w o u ld d o a s w e ll a t
h om e
39
0
20
1989
40
1992
54
71
60
80
1994
100
1995
Source: Canada Health Monitor.
Figure 94: Causes of Inefficiency:
Do Doctors Abuse the System?
“I feel some doctors encourage people to come for more visits than
are strictly necessary, in order to maintain income levels.”
D is a g re e
S tro n g ly
16%
DK/N A
2%
A g re e S tro n g ly
35%
D is a g re e
M o d e rate ly
18%
A g re e
M o d e ra te ly
29%
DK/NA = don’t know/not applicable.
Source: Ipsos-Reid, September 1995.
- 71 -
Canadians’ Thoughts on Their Health Care System
Figure 95: Causes of Inefficiency:
Do Patients Abuse the System?
“Many Canadians misuse the health care system and this increases
the costs.”
D is a g re e
11%
N e u tral
23%
A g re e
66%
Source: Ipsos-Reid, 2000.
Figure 96: Two Views on Ensuring Quality
Should we rely only on the judgement and independence of health care
providers, or should we ensure that decisions made by providers are
supported by the best research evidence?
12%
R e ly o n ju d g em en t o f
h ea lt h c a re p ro v id ers
75%
D ec is io n s b a s e d o n
b es t re s e a rc h e v id en c e
13%
N o re s p o n s e
0%
50%
100%
Source: Saskatchewan Commission on Medicare, 2001
- 72 -
Canadians’ Thoughts on Their Health Care System
Figure 97:
Two Views on New Drugs and Procedures
E v en if it m ea n s th a t s o m e n ew t ec h n o lo g ies , p ro c ed u res o r d ru g s a re n o t
a v a ila b le, w e s h o u ld c a refu lly ex a m in e th e m ed ica l ev id en c e a n d a d o p t
o n ly th o s e t h a t o ffer a clea r im p ro v em en t o v er o t h er a v a ila b le s o lu t io n s .
E v en if it m ea n s w e h a v e to p a y m o re fo r h ea lth c a re, it is im p o rt a n t t h a t
a ll n ew p ro c ed u res , d ru g s a n d tec h n o lo g ies a re m a d e a v a ila b le a s s o o n a s
t h ey a re a p p ro v ed .
N o R es p o n s e
38%
50%
12%
0%
10%
20%
30%
40%
50%
60%
Source: Saskatchewan Commission on Medicare, 2001.
Figure 98:
Willingness to Try Experimental Therapies
If you were very ill and conventional medicine did not work, should you
have the right to try a therapy which was experimental and which could
make you even sicker than you were?
100
80
75
78
78
80
83
87
60
60
40
20
0
N a t io n a l
A t l a n t ic
Quebec
O n t a r io
Note: Percent responding “yes”.
Source: Berger Health Monitor, March 2001.
- 73 -
M a n it / S a sk
A lb e r t a
B .C .
Canadians’ Thoughts on Their Health Care System
Figure 99:
Hours of Hospital Emergency Use
Thinking of the last time you went to the emergency room for yourself
or somebody else, at approximately what time in the day or night did
you go?
50%
37%
40%
28%
30%
23%
20%
12%
10%
0%
B e t w e en 6 a m
a nd noon
B et w ee n n o o n
a nd 6pm
B e t w e en 6 p m
a n d m id n ig h t
B e t w e en
m id n ig h t a n d
6a m
Source: Berger Health Monitor, March 1999.
Figure 100:
Alternatives to Hospital Emergency Service
If hospitals wanted to discourage people who did not really have an
emergency from using hospital emergency services, which ways
would you approve of…
100%
89%
87%
86%
75%
46%
50%
25%
12%
0%
P ro v id e a
S e n d p e o p le
C h arg e a
F a m ily
P u b lic
te le p h o n e
to w alk-in
s p e c ia l fe e
d o c to rs w o rk
a w are n e s s
s e rv ic e
c lin ic
n ig h ts a n d
c am p a ig n
w e e ke n d s
Source: Berger Health Monitor, March 1999.
- 74 -
Canadians’ Thoughts on Their Health Care System
Figure 101:
Support for Community Report Cards
“The federal government should give report cards about how well each
province is doing on things like health care and education.”
9%
DK
20%
O ppose
71%
S u p p o rt
0%
20%
40%
60%
80%
Source: Cutler/Mendelsohn, Institute for Social Research, 2000.
Figure 102:
Focus of Community Report Cards
Some people have said there should be Community Report Cards on Health so that
Canadians would have more information on health issues in their community. If
community health cards were established, should they concentrate on..
H e a lth o f th e p o p u la tio n in th e
c o m m u n ity , o n t h in g s s u c h a s p e o p le ’s
17%
h e a lth a n d fitn e s s , illn e s s in th e
c o m m u n ity , a n d n u tritio n .
P e rfo rm a n c e o f th e s y s te m o n th in g s
51%
s u c h a s w a it in g tim e s fo r tre a tm e n t a n d
q u a lity o f tre a tm e n t
24%
B o th
0%
Source: Berger Health Monitor, August 1998.
- 75 -
20%
40%
60%
Canadians’ Thoughts on Their Health Care System
Figure 103:
Importance of Community Report Cards
Setting up a system of health report cards in communities would cost several
million dollars. Some people say that if we spend billions on health care we
should spend at least a few million to let people know the state of health in
their communities. Others say the money would be better spent on providing
more health services . Would you prefer to spend “several million dollars” on...
R ep o rt in g o n
h ea lt h in t h e
co m m u n it y
19%
P ro v id in g m o re
s erv ices
77%
Source: Berger Health Monitor, August 1998.
Figure 104: Role of the Federal Government
Which opinion reflects your view of what the federal government’s
role in Medicare should be?
100%
81%
80%
60%
40%
16%
20%
3%
0%
Federal go vernm ent is
Federal governm ent
im po rtant in M edicare
sho uld not have a say
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
- 76 -
DK/N R
Canadians’ Thoughts on Their Health Care System
Figure 105: Support for National Pharmacare
If there were a national pharmacare program, should the pharmacare
program be based on a set of national principles or should each province
have its own pharmacare principles?
P ro v in c ia l
32%
p rin c ip le s
N a t io n a l
63%
p rin c ip le s
0%
20%
40%
60%
80%
Source: Berger Health Monitor, August 1998.
Figure 106: Federal Role
Which of the two following statements more closely reflects
your own view?
T h e g o v e rn m e n t o f C a n a d a 's ro le in t h e h e a lt h
ca re sy st e m is t o g iv e m o n e y t o p ro v in cia l
39%
g o v e rn m e n t s t o h e lp co v e r t h e co st s o f p ro v in cia l
h e a lt h ca re sy st e m s
T h e g o v e rn m e n t o f C a n a d a 's ro le in t h e h e a lt h
ca re sy st e m in clu d e s m o re t h a n h e lp in g t h e
p ro v in ce s p a y fo r t h e sy st e m - - it sh o u ld a lso
59%
e n su re t h a t a ll C a n a d ia n s, n o m a t t e r w h e re t h e y
liv e , h a v e a cce ss t o sim ila r le v e ls o f h e a lt h ca re
se rv ice s
Source: Ekos Research Associates, 2000.
- 77 -
Canadians’ Thoughts on Their Health Care System
Figure 107:
Federal Contribution to Health Care
How much of the money for health care in your province comes
from the federal government? Would you say it is about…
40%
32%
29%
32%
31%
BC
21%
19%
20%
A lb e rta
11%
9%
0%
8%
4%
2 %1 %
N one
About
About
About
10%
25%
50%
M o re
D o n 't
th a n
K now
50%
Source: Cutler/Mendelsohn, Institute for Social Research, 2000.
Figure 108: Under Whose Authority?
Please tell me whether you think each of these things should be under the
authority of only the federal level of government, primarily the federal level
of government, primarily the provincial level of government, or only the
provincial level of government… health?
50%
42%
40%
38%
44%
40%
39%
31%
P rim a rily / o n ly fe d e ra l
30%
24%
20%
16%
B o th e q u a lly
( v o lu n te e re d )
15%
10%
0%
1990
1994
2000
Source: Environics Focus Canada Surveys.
- 78 -
P rim a rily / o n ly p ro v in c ial
Canadians’ Thoughts on Their Health Care System
Figure 109: Who Should Take the Lead?
“Which government should be in charge of trying to fix problems with
the health care system: the federal government, the provincial
government, or should they have to work together on this?”
100%
83%
75%
50%
25%
13%
3%
0%
P ro v in c ia l
F e d e ra l
B o th
Source: Cutler/Mendelsohn, Institute for Social Research, 2001.
Figure 110: Who Should Lead?
Which level of government is the most appropriate to take the
lead role on health care?
F ed era l
W o m en
24
O n ta rio
23
A lb e rta
21
M a n ito b a
20
A tla n tic
18
Q ueb ec
17
B .C .
S ask.
11
75
60
14
68
7
67
12
71
8
74
6
60
22
76
7
15
D K /N R
68
9
14
M en
B o th
11
19
TO T A L
P ro v in c ia l
80
8
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
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Canadians’ Thoughts on Their Health Care System
Figure 111: Who Is to Blame?
Who is to blame for the health care system’s problems?
F ed era l
19
TO TA L
P ro v in c ia l
23
29
13
M a n ito b a
28
15
A tla n tic C a n a d a
27
A lb e rta
23
S a s k a tc h e w a n
23
Q uebec
N eit h er
7
48
7 1
5 2
53
31
45
21
2
3
7
47
17
3
8
48
22
12
6 2
47
15
15
D K /N R
50
B ritis h C o lu m b ia
O n ta rio
Both
6
3
41
62
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
Figure 112:
The Importance of National Standards
There’s been some discussion recently about the issue of “national standards
for health care” – that is, requiring all the provinces to provide the same basic
accessibility and quality of health care. In your view, how essential is it to
have national standards for health care across the country?
75%
63%
50%
25%
25%
7%
4%
0%
V e ry E s s e n tia l
S o m e w h a t Es s e n tia l
N o t V e ry E s s e n tia l
Source: Ipsos-Reid, March 1996.
- 80 -
N o t A t A ll Es s e n tia l
Canadians’ Thoughts on Their Health Care System
Figure 113:
Who Should Set National Standards?
In Canada, different provinces often have different standards for things
like health care. Which of the three following statements most closely
reflects your own view:
50%
47%
40%
30%
24%
25%
T h e fe d a n d p r o v g o v 't s
T h e fe d g o v 't sh o u ld se t
E a ch p r o v sh o u ld se t it s
sh o u ld se t n a t io n a l
st a n d a rd s
o w n st a n d a r d s
20%
10%
0%
st a n d a rd s t o g e t h e r
Source: Cutler/Mendelsohn, Institute for Social Research, 2000.
Figure 114:
Enforcement of the Canada Health Act
Should the federal government enforce the Canada Health Act by
withholding transfers?
60%
50%
49%
44%
40%
30%
20%
7%
10%
0%
W ith h o ld tra n sfe rs N o t a p p ro p ria te to
w ith h o ld m o n e y
DK/NR = don’t know/no response.
Source: Earnscliffe/POLLARA, 1998.
- 81 -
DK /N R
Canadians’ Thoughts on Their Health Care System
Figure 115:
Regional Variations on Withholding Money
Would you strongly support, somewhat support, somewhat oppose or
strongly oppose withholding federal government funds from those
provinces which do not meet the five principles (defined in previous
question)?
80%
65%
56%
55%
57%
52%
49%
45%
40%
0%
N a t io n a l
A t la n t ic
Quebec
O n t a r io
M a n it / S a s k
A lb e r t a
BC
Note: Percentages report total “support.”
Source: Berger Health Monitor, 1995.
Figure 116:
Who Should Be Involved in Policy?
“Who should play a lead role in setting policies to protect patients and ensure
the best care?”
B u s in e s s le a d e rs a n d e m p lo y e rs
12%
21%
A c a d e m ic s
21%
V o lu n ta ry h e a lth o rg a n iz a tio n s
23%
T h e p u b lic
34%
45%
30%
F e d e ra l g o v e rn m e n t
38%
P ro v in c ia l g o v e rn m e n ts
39%
H e a lth c a re p ro fe s s io n a ls
0%
T h e le a d ro le
37%
A s ig n ific a n t ro le
28%
31%
62%
25%
35%
50%
Source: Merck Frost/Pollara, 1999.
- 82 -
75%
100%
Canadians’ Thoughts on Their Health Care System
Figure 117: Spending on Social Programmes:
Socioeconomic Differences
In planning its budget for next year, which of the following do you
think the Government of Canada should put the most emphasis on?
In v e s tin g in s o c ia l p ro g ra m s
O VERALL
P a y in g d o w n d e b t
58
23
49
M a le s
23
68
18
71
< $20K
14
60
$ 2 0 K -$ 6 0 K
21
48
$80K+
40%
60%
14
18
37
20%
13
19
34
45
0%
18
28
F e m a le s
$ 6 0 K -8 0 K
T a x c u t fo r a ll
17
80%
100%
Source: Ekos Research Associates, Health Issues Tracking Survey, December 1998.
Figure 118: Quality and Access Trade-off:
Socioeconomic Differences
Which of the following aspects of health care is of greatest
importance to you?
70%
58%
50%
47%
48%
4 3 %4 3 %
38%
37%
30%
23%
0%
O v e ra ll
In co m e
In co m e
60K +
- 20K
Age - 65
Age 65
+
Q u a lity o f h e a lth c a re s e rv ic e s
Source: Ekos Research Associates, 2000.
- 83 -
E q u a l a c c e s s to a ll C a n a d ia n s
Canadians’ Thoughts on Their Health Care System
Figure 119: Support for Pharmacare:
Sociodemographic Differences
Do you think the Canada Health Act should be extended to cover
prescription drugs?
49%
N a tio n a l
68%
< $2 0,0 00
52%
$ 2 0 -$ 2 9 , 9 9 9
44%
$ 3 0 -$ 4 9 , 9 9 9
36%
$ 5 0 -$ 7 4 , 9 9 9
32%
$75, 000
0%
20%
40%
60%
80%
Note: Percentage saying “yes.”
Source: Berger Report, Canada Health Monitor, May-July 1996.
Figure 120:
Regional Variations on Privatization Models?
Do you personally strongly support, somewhat support, somewhat oppose,
or strongly oppose the proposal put forward by Premier Klein? (Bill 11
proposal defined in earlier questions.)
40%
33%
32%
30%
24%
19%
18% 18%
A lb erta
Rest of C a na da
12%
8%
7%
0%
S tro n g ly
S o m ew hat
S o m ew hat
S tro n g ly
s u p p o rt
s u p p o rt
oppose
oppose
DK = don’t know.
Source: Ipsos-Reid, 1999.
- 84 -
DK