Hot! Canadians want ‘fundamental changes’ to health care: survey

NationalPost.com – News/Canada
Wednesday, Nov. 17, 2010.   Tobi Cohen, Postmedia News

A majority of Canadians believe their beloved public health-care system needs an overhaul, according to a study released Friday that highlights serious gaps in access to care and affordable prescription drugs.

The Health Council of Canada report dubbed How do Canadians rate the health-care system, found more than half of those surveyed believe “fundamental changes” are needed to “make the system work better,” while another 10% think it needs to be “completely rebuilt.”

The study is based on the results of the 2010 Commonwealth Fund International Health Policy Survey and compares Canadian sentiment to that of residents in 10 other countries.

More than 20,000 adults in Australia, Canada, France, Germany, the Netherlands, NewZealand, Norway, Sweden, Switzerland, the United Kingdom and the United States completed the 100-question survey.

While overall confidence was found to be improving and quality of care was rated top notch, Canada came in dead last for access to primary care after hours.

Some 37% of Canadians said the hospital emergency department was really their only option during evenings, weekends and holidays and 47% — the second highest after the U.S. — admitted their ailment could have been looked after by their regular doctor.

“Despite all the funding and attention we pay to health care, Canadians are still not seeing it benefiting them as users,” Health Council CEO John Abbott said.

“Maybe we don’t have the best system in the world . . . Yes it’s universal, yes it’s publicly funded, but some other countries have similar systems and they have been able to perform much better than us in some things that are important to patients.”

According to the survey, Canada also came in last for same-day or next-day access to a doctor. Canadians were also the most likely to have to wait four or more weeks to see a specialist and one in five Canadians — the second highest after Norway — reported long wait times for a diagnosis on a condition they were worried about.

Swiss residents were among the least likely to have to wait a long time to see a specialist, get a diagnosis or a same or next-day appointment with a doctor. The U.K. and the Netherlands also fared well in terms of access, the study found.

Mr. Abbott blamed “inappropriate use of physician offices” more than doctor shortages for access issues and suggested Canada should make better use of other medical professionals, such as nurse practitioners and pharmacists.

It’s already happening in some jurisdictions. For instance, this week, Manitoba Premier Greg Selinger announced the creation of five “Quick Care” clinics to be run by nurse practitioners. The clinics will focus on minor health issues, be located in convenient places, such as shopping malls and offer patients extended hours.

But Mr. Abbott said family doctors also need to better manage their practices by triaging patients rather than booking them indiscriminately. Canada is also behind the times when it comes to electronic patient record-keeping and using email, for example, to book appointments, he said.

That too, has already been recognized as a problem and efforts are underway to rectify it, although it’s not been without challenges. Ontario, for instance, hopes to have all physicians on electronic health records by 2015 but a spending scandal, among other things, has hampered progress.

Dr. Robert Boulay, president of the College of Family Physicians of Canada, said most of the issues addressed in the report are ones the medical community is trying to tackle. That said, he’s not convinced everything can be resolved.

Extending office hours in his home province of New Brunswick didn’t, in the long run, reduce the number of emergency room visits. He believes Canadian geography — both its size and large number of rural areas — means hospitals will continue to play a major role in primary health-care delivery.

The survey found Canadians were among the least likely to avoid doctors due to cost, however, 10% — the third highest after Australia (13%) and the U.S. (21%) — said they did not fill a prescription or skipped doses for financial reasons.

The study also found there’s “room for improvement” when it comes to the sharing of information between family doctors and specialists.

“With 20% of Canadians saying their time has been wasted due to poorly organized and poorly co-ordinated care, Canada is the second lowest performing country in this area,” the study found.

Mr. Abbott called for “catastrophic drug coverage” to ensure no Canadian is left wanting for a prescription. He also said there should be more support for family doctors so they can modernize their practices.

He also pointed to the U.K.’s “patient-first” strategy which has proven successful.

“Some things may be important to governments, some things may be important to the health authorities, some things may be important to the physicians themselves, but if the patients aren’t recognizing that and they’re seeing that they have to wait longer than they need to, that they’re repeating their information every time . . . then we are really not meeting the patient’s true needs here,” he said.

“This is a human service industry and we really need to focus on the service side of this.”

Canadian Medical Association president Dr. Jeffrey Turnbull said patient concerns appear to be in line with those of the medical community and that the CMA is “supportive” of the study.

With the health accord — the funding arrangement between the provinces, territories and the federal government — set to expire in 2014, he said these are the issues that need to be front and centre.

“What we should take from this is fortunately, Canadians still have faith in their health-care system but they are very worried about many components . . . such as access and wait times and co-ordination of care and pharmaceuticals,” he said.

“Canadians recognize that we need transformative change in our health-care system. I think that that’s exactly what we’ve been saying and I’m glad to hear Canadians agree.”

How Canada stacks up:

• 76% of Canadians agree the quality of medical care they received is excellent or very good. Canada tied with Australia for the third-most satisfied patients in this area;

• 37% of Canadians say it’s hard to get care after hours and on holidays without going to the emergency room. Canada has the worst ranking followed by Sweden, the U.S. and Australia;

• 47% of Canadians think they could have avoided the emergency room if a primary care physician was available. Canada ranks second-last after the U.S., while patients in the Netherlands and U.K. were the least likely to experience this problem;

• One-quarter of Canadians, tied for fourth place with the U.S., are very confident they could afford care if seriously ill;

• 4% of Canadians avoided the doctor due to cost. Only the Netherlands and U.K. fared better in this area;

• 10% of Canadians didn’t fill a prescription or skipped doses because of cost. Only Australia (13%) and the U.S. (21%) were worse off;

• 21% of Canadians waited a long time for a diagnosis; slightly more Norwegians (24%) reported the same, while the U.K. and Switzerland were the least likely to report this problem;

• 43% of Canadians said they had to wait four or more weeks to see a specialist. Canada placed dead last in this area compared to Germany, Switzerland and the U.S. which were the least likely to report this problem.

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