Canada - World Health Organization Regional Office for Europe

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134 Health systems in transition Canada 7.3 User experience and equity of access to health care 7.3.1 User experience In response to growing levels of public dissatisfaction (see section 2.9 and Table 7.2) originally rooted in the public cost cutting of the early to mid-1990s, there has been a discernible trend towards reforms that will make the health system more responsive to patients. This movement, loosely termed patientcentred care, has become increasingly important in Canada as described in section 2.9.5. It is too early to determine the impact of these changes along with other provincial and territorial reforms aimed at making the system more responsive. Table 7.2 Patient views on waiting times, access and health systems, Canada and selected OECD countries, 2010 (% of respondents in Commonwealth Fund survey) Country Wait for elective surgery (> 4 months) Wait for specialist appointment (> 2 months) % of respondents Difficulty getting after-hours care without going to ED Access to doctor or nurse when sick Wait to see doctor or nurse when sick (> 5 days) Overall view that health system needs fundamental change or rebuilding Australia 18 28 59 65 14 75 Canada 25 41 65 45 33 61 France 7 28 63 62 17 58 Sweden 22 31 68 57 25 53 United Kingdom 21 19 38 70 8 37 United States 7 9 63 57 19 68 Source: Schoen, Osborn & Squires (2010). In the past decade, patient dissatisfaction has focused on the long waiting times for advanced diagnostics, specialist services and elective (non-urgent) surgery. Waiting times have also been an issue in some hospital emergency departments in urban centres. Finally, access to primary care – especially in those communities where there is a shortage of family physicians or where family physicians are refusing to take on new patients – has also fuelled patient dissatisfaction. These problems are reflected in a comparative study conducted by the Commonwealth Fund in 2010 (Schoen, Osborn & Squires, 2010). Table 7.2 presents the results of the Commonwealth Fund’s survey data for Canada and its five comparator countries. In terms of the patient experience with waiting times for elective surgery, specialist services and basic medical
Health systems in transition Canada 135 care access, Canada ranks behind Australia, France, Sweden, the United Kingdom and the United States. However, when it comes to the pressure on emergency rooms after regular hours due to the lack of 24/7 primary care, Canadians face roughly the same difficulty as patients in Australia, France, Sweden and the United States. In light of these poor results, it is not surprising that a majority of Canadians (61% in the sample) feel that the health system is in need of either major reform or rebuilding compared with the much larger percentage of Australians and Americans that have come to the same conclusion about their respective health systems. 7.3.2 Equity of access to health care The introduction of universal medicare improved access to, and the benefits derived from, hospital and physician services (Enterline et al., 1973; van Doorslaer & Masseria, 2004; James et al., 2007). Despite this important public policy change in the 1950s and 1960s, inequities persist. Although these inequities are concentrated in non-medicare sectors where financing is largely private, they are also present in some services associated with medicare. Lower income Canadians tend to use acute inpatient services more than higher income Canadians but there is a pro-rich bias in terms of the use of specialist physician services, as well as day surgeries (Allin, 2008; McGrail, 2008). While the evidence concerning primary care is mixed, one fine-grained study of British Columbia found that there was a higher use of primary care physicians among poorer Canadians (McGrail, 2008). One study found persistent inequities based on both education and income in the utilization of mental health services (Steele et al., 2007) – a troubling result given the increased incidence of mental illness in Canada. Other studies highlight the degree to which inequities exist in the use of non-medicare services, including dental care, rehabilitation, physiotherapy, occupational therapy and speech pathology (Hutchison, 2007; Grignon et al., 2010). In Canada, the goal of achieving greater regional equity has also shaped health system financing. This “geographical” equity is pursued through two instruments: the first is equalization and the second is the Canada Health Transfer, two of the federal government’s largest annual expenditures. First introduced when universal hospital insurance was established nationally, equalization payments from the federal government provide provincial governments that have shallower tax bases with the funding capacity to administer programmes such as medicare. By the early 1980s, equalization was considered such an important dimension of the federation that it was made part
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Contents Preface . . . . . . . . .
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Preface The Health Systems in Trans
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Acknowledgements The HiT on Canada
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Abstract Canada is a high-income co
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Canada - World Health Organization Regional Office for Europe

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