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What a Difference a Few Years Can Make!

Public opinion in the past decade in Canada has been dominated by economic issues. But it comes as no surprise to those of us working in the hospital sector that there is growing concern over the state of the Canadian healthcare system, the quality of care being delivered, and in particular, the ability of Canadians to get timely access to the care they need, when they need it.

This concern exploded last quarter, with healthcare becoming the top issue in every region of the country for the first time since the national Medicare debates in the 1960s. Healthcare's move to the top of the opinion agenda is fueled by dramatic increases in Atlantic Canada (35%, up 25% since last quarter) and Ontario (29%, up 18%). However, increases are also recorded in the Prairies (29%, up 14%), Quebec (19%, up 11%), and BC (21%, up 7%).

Most Important Issue Facing Canada, by Region
Issues Atlantic
Health Care 35 (+25) 19 (+11) 29 (+18) 29 (+14) 21 (+7)
Economy 7 (-2) 13 (-2) 8 (-1) 7 (-1) 8 (-4)
Unemployment 13 (-14) 6 (-6) 7 (-6) 7 (+1) 10 (-2)
Gov't Spending 3 (-2) 8 (-5) 5 (-3) 10 (+2) 8 (-8)
Taxes 8 (n/c) 3 (-1) 9 (-2) 8 (-5) 10 (-2)
National Unity 3 (-2) 14 (+2) 3 (-4) 3 (-4) 3 (-2)
Education 2 (-2) 3 (+2) 5 (-1) 2 (-1) 3 (-2)

Canadians over the age of 55 have become significantly more likely to cite healthcare as the most important issue facing the country this quarter (up 24%). Forty percent of women in this age group now cite the issue as Canada's most important issue.

While some pundits have suggested that healthcare's stay at the top of the agenda will not last, public opinion is displaying symptoms that suggest the possibility of a chronic state of affairs. These symptoms include:

Declining Confidence

Confidence in the healthcare system is still on the decline with the Canadian public. The majority of the Canadian public (55%, down 4%) says their confidence is falling, rather than rising (5%, no change) or holding firm (38%, up 3%). Healthcare providers, who send most of the direct and indirect cues to hospital patients on how the system is functioning, are even more pessimistic than the public.

Only 3% of physicians say their confidence is rising, while most physicians (70%) admit their confidence is falling. Similarly, 62% of nurses are losing confidence in the healthcare system. Pharmacists, on the other hand are more optimistic as just 47% say their confidence is falling, while an equal number say their confidence has remained unchanged (44%).

Confusion over Funding

There is little consensus as to whether the amount of money going into the healthcare system is rising (26%), falling (39%) or is the same as it ever was (30%). The reinvestment message from governments has not yet penetrated the public mindset. Nonetheless, the public has clear and strongly held views about the way that governments should budget for healthcare in the future.

There is general agreement (73%) that governments should spend more money to meet the healthcare needs of Canadians, assuming that governments continue to work on cost-efficiencies in the healthcare system. Healthcare professionals (82% physicians, 81% nurses, 75% pharmacists) also agree that more money is needed to fund the healthcare system.

But only 45% (down 1%) have at least some confidence that current governments are planning to ensure that the infrastructure and finances to manage the future demand of the aging population are in place. A majority (54%) lacks this confidence.

Perceived Directions in Quality and Timeliness of Access

There is near universal agreement in Canada (98%) that timely access to healthcare should be available to everyone.

Despite the importance the public attaches to timely access to medical care, and the potential consequences for patient behaviour if timely access is not provided, very few Canadians (15%) believe we are making progress in this crucial area. Instead, most believe we are losing ground (45%) or standing still (38%).

A considerably higher number of healthcare providers are of the opinion that timely access to health care is falling behind (84% of physicians, 72% of pharmacists, 65% of nurses).
If timely access was not available, almost three-quarters of Canadians (73%) feel that patients should have the option of seeking private care utilizing their own resources. Whether one agrees or disagrees with the policy, it is this sentiment that the Alberta government has responded to with its Bill 11.

While most Canadians think that our quality of health- care is still good, a plurality (42%) hold the pessimistic view that the quality of health care is slipping, while just 20% believe it is advancing and 37% characterize it as standing still. Healthcare providers such as doctors and nurses are even more likely than the public to believe that the quality of healthcare is falling behind (55% of physicians, 53% of nurses), while pharmacists are less pessimistic (39% believe the quality of healthcare is falling behind).

A New Public Involvement?

Given these findings, it is not surprising that a large majority of Canadians (77%) believe it would be worthwhile to have publicly available report cards that would evaluate the quality of care in various areas such as hospital care, community care, home care and provincial drug plans. This is a clear indication of a public demand for increased accountability in the management and delivery of healthcare.

The public is also showing a growing desire to become more informed and more involved in the decision-making around its own healthcare. The World Wide Web is now the second most commonly consulted source of information on healthcare, following the family doctor.

What does all this mean? It means growing, not shrinking, public concern, interest and engagement in all matters concerning healthcare in the years to come. It means more public attention, scrutiny and involvement to everything that goes on in a hospital setting, and out in the community. And it means another challenge for healthcare administrators. But there is nothing new there!

Next time:

What the public worries about in the scramble for home care and how they decide what ranges of care are most important to them.

About the Author

Don Guy is Senior Vice President with POLLARA Inc.


This information is provided with the kind permission of the Ontario Hospital Association. The OHA subscribes to the Pollara consumer research to provide its members a snapshot of public concerns with the healthcare system and the hospital sector.