Healthcare Quarterly

Healthcare Quarterly 21(1) April 2018 : 13-18.doi:10.12927/hcq.2018.25522
Public Opinions on Pharmacare

Healthcare in Canada: Choices Going Forward

Terrence Montague, Bonnie Cochrane, Amédé Gogovor, John Aylen, Lesli Martin and Joanna Nemis-White

Abstract

The overarching purpose of serial Health Care in Canada (HCIC) surveys of the adult Canadian public and a broad spectrum of healthcare professionals over the past two decades has been the development of an evidence-based map to inform strategic and clinical decisions to improve care and outcomes for Canadians. Recent surveys reveal a growing concern that medicare may require complete rebuilding or major strategic repairs. On the other hand, a majority of stakeholders perceive continuing underlying quality in our clinical care and look forward to both system- and patient-centred initiatives to improve future care. Currently, the most strongly supported strategic improvement target among the public and professional caregivers is enhanced availability of less expensive prescription medications. With regard to practical implementation of this strategy, the public's (39%) and healthcare professionals' (39–54%) preference was institution of a nation-wide pharmacare plan, funded by a federal tax. There was also pan-stakeholder concordance around the two least favoured potential strategies: increasing taxes and shifting money from other funded services. In terms of improving clinical care, the public and all professional groups were also concordant in most strongly supporting increases in home and community care services, disease prevention/wellness education and use of non-physician care providers and electronic health records. There was also remarkable concordance regarding who is most responsible for implementing these preferred innovations: research hospitals/health authorities, government funding agencies and pharmaceutical/biotech industries. In summary, contemporary Canadian public and health professionals agree on key strategic and practical priorities to improve future care and outcomes. Moreover, they concur on who should lead their implementation. This public/professional concordance supporting evidence-driven choices and leadership for improving care is not common. It is, however, an opportunity, providing a call to arms for other stakeholders, particularly governments and industry, to recognize the opportunity and their leadership expectations and to act upon them. Things can be better.

Introduction

Repeated Health Care in Canada (HCIC) surveys (1998–2016) have measured the adult public's and health professionals' sense of key variables influencing our health, health system and patient care (Ahmed et al. 2009, Ahmed et al. 2014; Gogovor et al. 2016; Montague 2004; Montague et al. 2014, Montague et al. 2016; Nemis-White et al. 2014). The principal goals of the HCIC surveys' data have been, and remain, the measurement, communication and utilization of knowledge to promote use of evidence-based health system and clinical interventions to improve patients' health management (Montague 2004, Montague 2006; Nemis-White et al. 2014).

Most Canadians continue to perceive quality in delivery of their personal healthcare. However, a growing majority, 72% in the 2016 HCIC survey, also feel the system needs complete rebuilding or fairly major repair, compared to 57% of the public who felt similarly two decades ago. The contemporary opinions of Canada's healthcare professionals mirror those of the public, with a perceived contemporary need for complete rebuild, or major repairs, ranging from 73% among pharmacists to 84% among nurses, with physicians, allied professionals and administrators falling in between.

The magnitude of these numbers merits consideration. The primary purpose of this paper is to summarize the contemporary visions of public and professional stakeholders regarding the priority value of various system and clinically specific initiatives likely to improve future healthcare quality and outcomes as well as their choices for leaders to successfully attain improvement goals.

Data Sources and Management

The principal data sources for this paper were the solicited views of representative samples of the adult Canadian public and a broad spectrum of clinical and administrative health professionals, polled online in the summer of 2016.

The 2016 HCIC survey included 1,500 adults in the public sample. The professional groups' sample sizes were doctors (n = 102), nurses (n = 102), pharmacists (n = 100), administrators (n = 100) and allied professionals, including physiotherapists, occupational therapists, dietitians, social workers and psychologists (n = 100). Where appropriate, the 2016 HCIC survey results were compared to results from similar questions in previous HCIC surveys.

As with all previous HCIC surveys, POLLARA Strategic Insights supported the formatting and collation of questions and responses, with input from HCIC members: Canadian Cancer Society; Canadian Foundation for Healthcare Improvement; Canadian Home Care Association; Canadian Hospice Palliative Care Association; Canadian Medical Association; Canadian Nurses Association; Canadian Pharmacists Association; Constance Lethbridge Rehabilitation Centre/Centre for Interdisciplinary Research in Rehabilitation; McGill University; Health Charities Coalition of Canada; HealthCareCAN; Institute of Health Economics; Studer Group Canada; Merck Canada; Strive Health Management and CareNet Health Management Consulting.

Improving the Health System

From an overarching system viewpoint, the 2016 HCIC survey's public and health professional sample populations were asked their degree of support for possible strategies to improve future Canadian healthcare. The results are graphically presented in Figures 1 and 2.


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There was pan-stakeholder concordance around the two most strongly supported proposals: provision of less expensive versions of prescribed drugs and establishment of national supply systems to reduce costs of medical treatments (Figures 1 and 2). There was a similar concordance among the public and health professionals for options least favoured to make things better: increasing taxes and shifting money from other government-funded services. On the other hand, while doctors, pharmacists and, to some extent, administrators found the concept of user fees to be an acceptable solution, it was not met with wide approval by nurses, allied health professionals or the public (Figures 1 and 2).

The degree of stakeholder unanimity around preferred key paths for future progress in the Canadian healthcare system is more than a mathematical curiosity. Rather, it suggests a sophisticated, evidence-aware and frugally sensitive mindset among major healthcare stakeholders. Moreover, it generates a sense of optimism that emerging choices for improvement might bridge stakeholders' sometimes-divergent partisan interests.

Improving Clinical Components of Healthcare

In the 2016 HCIC survey, all proposed clinically oriented care improvement initiatives were favoured by the public; most support was observed for technically oriented pathways such as enhanced use of electronic medical records (Figure 3). Most also represented increased levels of support compared to previous surveys (Figure 3).


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Among health professionals, universally, the top-supported option to improve clinical care was, similar to the public's top choice, increasing access to home and community care (Figure 4). Increasing the use of non-physician healthcare providers, such as nurse practitioners, was also rated very highly by professionals, although less so among the physician cohort (Figure 4).


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Prescription Drugs – A Key and Prevalent Therapy in Healthcare

Medications are the most frequently prescribed intervention in Canadian medical care to improve patient health outcomes. They are used by almost half of the adult population on a daily basis, with an average rate of more than three prescriptions per patient, mainly to manage chronic conditions. In terms of pan-stakeholder support, the most favoured initiative to likely make things better in optimizing access to prescribed medications is a single nation-wide and federal government-supported pharmacare plan (Figure 5). This proposed initiative was supported by 39% of the public and, on average, by 47% of health professionals, ranging from 39% among physicians to 54% among administrators (Figure 5). All other proposed initiatives to improve accessibility to prescription medications were rated considerably lower in potential population effectiveness (Figure 5).


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The strongly stated concordant preferences of all stakeholders on how to practically enhance medication accessibility suggests similar thinking on how to best balance treatment efficacy and costs using a viable approach to clinically enhance, and fiscally sustain, improved patient care and outcomes.

Responsibility for Improving Healthcare in Canada

There are many vested interests in Canadian healthcare. Among the many interests, an important question is: "Who is most responsible for making things better?"

The data summarized in Figures 6 and 7 provide a contemporary overview of the Canadian public's and health professionals' answers to this question.


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Again, there was remarkably strong pan-stakeholder agreement among the public and all health professionals regarding their top choices of who should lead the implementation of healthcare innovations in Canada. The hoped-for leaders are research hospitals/health authorities, governments and the pharmaceutical/biotech sector (Figures 6 and 7).

Conclusions

The results of the HCIC surveys suggest a balanced, evidence-informed and evolving grasp, by the Canadian public and professional healthcare providers, of the key challenges, choices and opportunities medicare faces going forward.

In particular, recent surveys define a remarkable concordance around the highest-ranked priorities for both system strategies and clinical innovations likely to make future practices and outcomes better. The data also reveal a similar concordance in terms of who holds primary responsibility to lead the institution of the priority innovations to improve care, namely research hospitals/health authorities, governments and the pharmaceutical/biotech industries.

Whether the perceived change leaders in health authorities, government and the health industries will embrace the leadership expectations of the public and care professionals remains uncertain. What is certain, however, is that "improving care is an enabler – a call to arms for all stakeholders" (Montague 2006).

The goals are clear. Things can be better.

About the Author

Terrence Montague, CM, CD, MD, is principal, CareNet Health Management Consulting Ltd., and adjunct professor of medicine, University of Alberta, Edmonton, AB.

Bonnie Cochrane, RN, MSc, CHE, is vice-president, partner development, Studer Group, and general manager, Studer Group Canada, Mount Pearl, NL.

Amédé Gogovor, DVM, MSc, is a PhD candidate and research assistant, Faculty of Medicine, McGill University, Montréal, QC.

John Aylen, MA, is president, John Aylen Communications, Montréal, QC.

Lesli Martin, BA, is vice-president, public affairs, Pollara Strategic Insights, Toronto, ON.

Joanna Nemis-White, BSc, PMP, is principal, Strive Health Management Consulting Inc., Halifax, NS.

References

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Montague, T. 2006. Patient Health Management for Dummies. Mississauga, ON: John Wiley & Sons Canada Ltd.

Montague, T., A. Gogovor, L. Marshall, B. Cochrane, S. Ahmed, E. Torr, J. Aylen and J. Nemis-White. 2016. "Searching for Best Direction in Healthcare: Distilling Opportunities, Priorities and Responsibilities." Healthcare Quarterly 19(3): 44–49.

Montague, T., J. Nemis-White, L. Marshall, A. Gogovor, E. Torr, S. Ahmed et al. 2014. "Recent Health Care Trends in Canada: Perceptions of Quality, Access and Affordability; Priorities for Improvement, 1998–2014." Retrieved August 6, 2016. <https//:www.mcgill.ca/hcic-sssc/files/hcic-sssc/hcic_trends_quality_access_affordability_2015.pdf>.

Nemis-White, J., E. Torr, A. Gogovor, L. Marshall, S. Ahmed, T. Montague; for the Health Care in Canada Survey Members. 2014. "Stakeholder Surveys of Canadian Health Care Performance: What Are They Telling Us? Who Should Be Listening? Who Should Be Acting, and How?" Healthcare Quarterly 17(4): 22–27.

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