2011 Survey of Health Care Consumers in Canada Key Findings, Strategic Implications

Transcription

1 2011 Survey of Health Care Consumers in Canada Key Findings, Strategic Implications Produced by the Deloitte Center for Health Solutions

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3 Contents Foreword 4 Introduction 5 Survey highlights 7 Zone One: Wellness and healthy living 10 Zone Two: Information resources 12 Zone Three: Traditional health services 15 Zone Four: Alternative health services 20 Zone Five: Health insurance 21 Zone Six: Health policy 22 Major findings 26 Stakeholder implications 27 Closing thoughts 29 Contacts Survey of Health Care Consumers: Canada 3

4 Foreword In 2009, we engaged with Canadians to understand the factors that influence their attitudes and behaviors towards their own health, their interactions with their care providers, and relationship with the health system at large. Through our 2009 publication, Treating Patients as Consumers, the need to shift toward consumer-oriented health care in Canada was clear. As part of Deloitte Canada s ongoing commitment to the health system in Canada, we have once again engaged with Canadians and the findings and insights provided emphasize the need for system leaders to harness the power of the individual as a positive, disruptive force of innovation as consumer-oriented health provides a path to health system transformation across the country. In our view, health consumerism needs to be recognized as a major driver of health system transformation. Individuals have the ability to transform the delivery of health care across the country through evolving expectations, willingness to engage in their own health management through self-care and remote monitoring, and a realization of the important connection between economic stabilization and the health of our health system. Finding strategies to provide customized health solutions to meet consumer needs within an equitable funding and policy framework will be one of the greatest challenges in evolving the health system; more so in this time of fiscal constraint. Connecting these drivers of change and focusing on the health consumer as an empowered individual rather than a dependent patient will enable health system leaders to more effectively collaborate on solutions that truly engage the individual in their own health and well-being management. For health consumers, becoming more actively involved in understanding the health system, maintaining their own self-care, and actively engaging in dialogue about the evolution of the health system will be critical for new models to evolve that meet Canadians needs and expectations. In health care, the role that individuals play in choosing doctors and hospitals, treatment options, and insurance coverage is becoming increasingly important. In many of the world s health care systems, that role to date has been minimal; however, it is clear that engaging individuals to become more active increases the likelihood of better care and lower costs. This survey of health care consumers in Canada offers a glimpse of current opinions and activities as a baseline for future trend analysis. Concurrently, Deloitte conducted surveys in 11 other countries to compare consumer attitudes and behaviors in varied circumstances and systems of care. In most systems, consumers role in managing their health has been secondary; physicians and hospitals have made most of the decisions on their behalf. Looking forward, though, it is apparent that the emergence of technologies that assist consumers in decision-making and anticipated limits on funding for health care systems, will require new approaches to population health management. Equipping consumers to be more active, engaged, and accountable for their care and the associated costs may be an important new dimension for health care system improvement. Paul H. Keckley, PhD Executive Director Deloitte Center for Health Solutions Washington, D.C. Lisa Purdy Partner National Health Services Leader Deloitte 4

5 Introduction How do health systems perform from the viewpoint of the citizens served? Do individuals understand their treatment options and respond accordingly? Are choices of physicians and hospitals made based on objective information about quality, service, and cost? Are prescription drugs and alternative courses of care thoughtfully considered by consumers when recommended? Are mechanisms to mitigate financial risk via insurance or personal spending managed effectively, or are costs for health care forcing compromises for families? These questions are at the centre of a global discussion about how organized health systems whether government-run or private relate to their end users, consumers. In 2011, the Deloitte Center for Health Solutions surveyed adults in 12 countries to gauge opinions and expectations about their health care systems. Across these countries there are many differences in health care systems structures and operations as well as in the political and economic thrusts of national health care transformation. Citizens in each of these countries differ widely in their social, cultural, economic, and generational viewpoints; however, they are all end users of health care and hold strong views on the performance of their respective systems and what they expect to receive from health care. In this report, we offer a baseline analysis about health care consumerism in Canada. Health care consumerism: Conceptual framework for this study Conducted annually in the U.S. since 2008, Deloitte s longitudinal study of heath care consumers seeks to provide a comprehensive view of health care consumerism, a view that goes beyond the conventional boundaries of what health and health care are commonly thought to encompass. In addition to the traditional services that doctors and hospitals provide, the study s framework takes into account the expanding spectrum of treatment alternatives, delivery settings, information sources, and programs that are coming into existence to promote wellness and self-care, address health needs, and finance health care. Now in its fourth year, and the second year for Canada, the 2011 survey continues to build on previous years surveys by exploring consumers behaviors, attitudes, and unmet needs in six areas (Figure 1): Wellness and healthy living Information resources Traditional health services Alternative health services Health insurance Health policy Figure 1: Zones of health care consumer activity 2. Information resources 1. Wellness and healthy living 3. Traditional health services Health care consumerism 6. Health policy 4. Alternative health services 5. Health insurance 2011 Survey of Health Care Consumers: Canada 5

6 This year, Deloitte surveyed health care consumers in Belgium, Brazil, Canada, China, France, Germany, Luxembourg, Mexico, Portugal, Switzerland, the United Kingdom, and the United States (Figure 2). Figure 2: 2011 surveyed countries Highlights of Canada s results are included in this summary. A global report, which contrasts findings from the 12 countries, and separate country reports can be found at Canada U.S. Europe China Survey methodology Mexico A nationally representative sample of 2,304 Canadian adults, aged 18 and older, was surveyed in April 2011 using a web-based questionnaire. The sample was representative of the nation s population, as reflected in the 2006 census, with respect to age, gender, income, and province. The margin of error is +/- 2.0% at the.95 confidence level. Brazil Belgium France Germany Luxembourg Portugal Switzerland UK The survey consisted of 84 questions, with 33 potential follow-up questions. English and French versions were available. Participants were asked about behaviors before attitudes within each topic area to reduce response bias. In this report, comparisons are made to results from Deloitte s previous health care consumer survey (2009); however, differences in question wording and response scales arising from efforts to improve and develop the survey instrument may preclude direct comparison in some cases. Questions will be repeated periodically in the survey series and new questions will continue to be introduced to keep pace with consumerism in health care as it evolves. Background: Canada s health care system Canada has a national health system, governed and delivered by each provincial jurisdiction. Provincial health insurance coverage is universal and portable across provinces. Three-quarters of the population have private supplemental health insurance, primarily through employers. Private spending for insurance, drugs, and out-of-pocket expenses totals 30 percent of the country s annual health care spending. Hospitals and regional health systems are not-for-profit corporations funded primarily by provincial governments, and physicians are paid through a mix of fee-for-service (FFS) and salary compensation. Financing for publicly funded services comes from provincial and federal taxes. 6

7 Survey highlights Consumer perceptions of Canada s health care system performance Canadian consumers report a low understanding of the health system, evaluating the system on their experiences vs. a studied view; however 4 in 10 believe it compares well globally, while one-third believe that it is wasteful. 5% of Canadians give the performance of the Canadian health care system a grade of A (excellent), little changed from the 3% in Other grades were B 45%; C 36%; D 10%; and F (failing) 4% (Figure 3). 33% of consumers feel that they have a strong understanding of how the health care system works, compared with 37% in 2009 who felt similarly. Most consumers (69%) feel that there has been no change in the health care system s performance as compared to two years ago. 18% believe that performance had become worse, with 8% suggesting that it had improved. Boomers (those born between 1946 and 1964) perceive system performance to have deteriorated (22%), as do those with fair to poor health status (26%), and those with three or more chronic conditions (25%). 36% believe that 50% or more of health care spending is wasted (26% in 2009) (Figure 4). 54% feel that money is wasted because individuals fail to take responsibility for their own health, while 42% blame redundant paperwork and 30% attribute waste to end-of-life heroic measures that are pursued instead of offering pain relief and palliative care. Figure 3: Report card grades of overall health care system performance Using a typical report card scale with grades of A, B, C, D, and F, how would you grade the overall performance of Canada's health care system? 100% 80% 60% 40% 20% 0% 3% 5% 43%/50% 2009 Canada 2011 Canada 40% 45% 42% A B C D F Favorable grade Note: Bars may not sum precisely to the totals above due to rounding. 36% 12% 10% 15%/14% 3% Unfavorable grade Figure 4: Perception of wasted health care spending The Canadian health care system spends approximately $190 billion on health care each year, which is more than $5,600 per person per year. In your opinion, what percentage of all health care dollars spent are wasted? 100% 80% 4% Consumers in Canada believe that the system should provide better service to its constituents. Close to one-third of consumers (32%) are satisfied with the health care system s performance and 15% feel that the government is managing to balance system priorities. 60% 40% 20% 0% 26%/36% believe 50% or more is wasted 26% 19% 14% 16% 18% 13% 11% 13% 14% 9% 9% 5% 10% 8% 5% 4% 3% 3% 1% 1% 0-9% 10-19% 20-29% 30-39% 40-49% 50-59% 60-69% 70-79% 80-89% % Note: Bars may not sum precisely to the totals above due to rounding Canada 2011 Canada 2011 Survey of Health Care Consumers: Canada 7

8 The economic downturn has altered Canadians use of the system: half are now more cautious about spending on health care, and 6 in 10 feel insecure about their ability to handle future health care costs. Over half (54%) of consumers say that the recent economic slowdown has had some impact on how much they are willing to spend out-of-pocket on health care services and products. Of these, 41% are more cautious about spending, 10% say they cut back, and 3% say they reduced their spending substantially (Figure 5). For 40% of consumers, spending on health care limits their household s ability to spend money on other essential items: spending is greatly limited for 4%, moderately limited for 13%, and slightly limited for 23%. 38% feel that their household is financially prepared to handle future health care costs as compared with 40% in 2009 (Figure 6). Among the 26% of consumers who say they decided to delay or not follow a recommended course of treatment in the past year, 24% cite costs as the reason. In particular, Generation Y (those born between 1982 and 1993) is unwilling to pay the cost of health care (40%). Figure 5: Impact of the economic slowdown on out-of-pocket health care spending Thinking about how much money you spend out of your own pocket on health care, to what extent has the recent economic slowdown made you reconsider how much you are willing to spend on health care? 100% 80% 60% 40% 20% 0% 2011 Canada 45% No impact 41% 10% Slight impact Significant impact High impact Figure 6: Financial preparation for future health care costs To what extent do you feel your household is financially prepared to handle future health care costs? 3% 100% 80% 60% 11%/16% 40%/38% 40% 20% 0% 20% 21% 19% 11% 13% 15% 12% 11% 4% 5% 5% 5% 6% 8% 5% 2% 11% 9% 10% 8% Not prepared Prepared Note: Bars may not sum precisely to the totals above due to rounding Canada 2011 Canada 8

9 Most people report they spent out-of-pocket on over-the-counter products (93%), pharmaceutical items (86%), and health insurance (77%). Almost twothirds feel they received good value for out-of-pocket spending for physicians and medical specialists (63%), MRI and imaging services (62%), and pharmaceutical items (57%). Least value for out-of-pocket spending is found for insurance premiums (21%), MRI and imaging services (15%), and rehabilitation services (15%) (Figure 7). 1 in 7 Canadian consumers has responsibility for the care of family members or friends, an increase from 2009, suggesting this continues to be a significant element of the Canadian consumer health care experience. 13% of consumers report providing care for another individual (10% in 2009). Of consumers who report caring for other individuals, 35% care for individuals under the age of 18, 12% care for individuals between ages 18 and 25, 23% care for individuals between ages 26 and 45, 23% care for individuals between ages 45 and 64, and 18% care for individuals % care for individuals in more than one age group. Care is provided primarily by the recipient s spouse (33%), parent (27%), son or daughter (19%), extended family members (9%), government (8%), or paid for out-of-pocket (4%). Consumers report that care duration varies: Less than 12 months (32%) Between 1 and 2 years (11%) More than 2 years (33%; 38% in 2009) Uncertain of care duration (24%). 70% of family caregivers report some impact on their income-generating capacity; for some (23%), this represents a major limitation on their ability to earn an income. Figure 7: Perceived value for out-of-pocket spending % of total respondents who spent out-of-pocket in past year in categories Best Value (rating of 4 or 5) Least Value (rating of 1 or 2) Over-the-counter products 93% 51% 15% Pharmaceutical items 86% 57% 14% Health insurance 77% 46% 21% Physicians & medical specialists 59% 63% 11% Services such as rehabilitation 40% 54% 15% Diagnostic imaging (e.g., MRI, CT) 36% 62% 15% 2011 Survey of Health Care Consumers: Canada 9

10 Zone One: Wellness and healthy living Although the majority of Canadians report they are in good physical and emotional health, the rate of chronic disease is increasing in the population and has a major impact on consumers and the health system. 55% of consumers rate their overall health as excellent or very good (Figure 8) (60% in 2009). Consistent with 2009, 63% report their emotional wellbeing as being excellent or very good. More people report having been diagnosed with one or more chronic conditions (52% compared with 47% in 2009) (Figure 8). 24% say they had one chronic condition, 18% had two, 9% had three or more chronic conditions, and 1% preferred not to say. Chronic conditions that consumers report include musculoskeletal problems (18%), heart disease (14%), respiratory problems (10%), diabetes (7%), and mental health issues (7%). 26% say they treated a health problem with an alternative approach or natural therapy in the past 12 months (25% in 2009), and 19% consulted an herbalist, homeopath, chiropractor, or other alternative health care practitioner or advisor. Figure 8: Self-reported health status and chronic conditions In general, how would you rate your overall health? Have you been diagnosed by a doctor or other medical professional as having one or more chronic conditions? 100% 80% 60% 40% 20% 0% 13% Excellent 2011 Canada 42% 34% Very Good Good Fair Poor One or more chronic Self-reported health status conditions 9% 2% 52% Use of preventive services is widespread, with consumers interested and making use of both publicly provided and privately paid options; in particular, year olds are highly interested in new public tax models that would reward healthy living. Over 7 in 10 consumers report that they used preventive or wellness services in the past 12 months. Over three-fourths visited their physician in the past year for a routine check-up (77%), 1 in 3 received a flu shot (37%), and 36% had an imaging exam or test in the past year (Figure 9). Women, in particular, used such services as regular check-ups (81%) and screening tests or examinations (43%). Utilization of preventive and wellness services increased with age. Figure 9: Wellness and preventive behaviors Which of the following have you done in the last 12 months? Took vitamins, minerals, or herbal supplements Visited a doctor for a routine check-up Chose a food for its health benefit Got a flu shot Had an imaging exam or test Participated in a healthy living/wellness program 16% 37% 36% 62% 77% 77% Consulted a personal trainer 8% 0% 20% 40% 60% 80% 100% 2011 Canada 10

11 Around three-fourths of consumers regularly take vitamins and minerals (77%) (Figure 9). This is particularly true for women (83%) as compared to men (71%), and for Seniors (those born ) (82%) compared with younger adults (Generation Y [71%], Generation X [those born ] [75%]). People with two or more chronic conditions regularly take supplements (72%) and functional foods (48%) to improve their health. 62% say they chose particular foods for their health benefits (Figure 9) and 10% used natural therapy(ies) to improve or maintain their health. 8% report they consulted a personal trainer (Figure 9) and 27% took over-the-counter medication(s) on a regular basis in the past year to treat a health condition or to improve health. Many favor a tax-based incentive to encourage healthy living, with 63% favoring a tax deduction. This is popular with those years old (69%), whereas both Boomers (15%) and Seniors (18%) are opposed to the idea. Participating in a wellness program is attractive to many regardless if an incentive is involved 58% indicate that they would participate in a wellness program if it was free (56% in 2009) or if it offered a financial incentive (59% as compared to 58% in 2009). However, similar to 2009, just 16% report actually participating in a health and wellness program in the preceding 12 months (Figure 9). To maintain or achieve a better level of health, one in four says they need coaching or professional assistance. Consumers say they need assistance from a: Nurse call line (39%) for health care advice (40% in 2009) Personal health coach (24%) to create and stick to a personal health plan (29% in 2009) Care coordinator (23%) to navigate the system (24% in 2009). Consumers efforts to improve or maintain their health include being focused on diet, reducing stress, exercise, and other activities (Figure 10). Figure 10: Effort put into improving or maintaining health Feeling good emotionally and mentally 53% 53% Eating a healthy diet 53% 49% Understanding health risks 52% 54% Being socially connected with others 46% 47% Reducing stress/relaxation 44% 42% Weight management 44% 42% Improving sleep 43% 42% Manage chronic conditions 42% 44% Regular exercise 40% 39% 2011 Survey of Health Care Consumers: Canada 11

12 Zone Two: Information resources The Internet is an important source of information for many consumers, but its use for health care information lags similar consumer use for banking, shopping, and travel. Figure 11: Trust in information sources If you wanted information about the most effective and safe treatment(s) for a certain health condition, how much trust would you have in the following third-party sources to provide reliable information? 8 out of 10 say they used the Internet in the past year for online banking (88%), to purchase merchandise (81%), or to reserve travel (73%); 54% report they looked online for information about treatment options (60% in 2009). This is consistent across all generations, with Generation Y (52%), Generation X (56%), Boomers (54%), and Seniors (53%) searching online. 20% report searching online for information about the quality of care provided by a specific physician or specialist; in particular, Generation Y (25%) and Generation X (27%). Online access to quality information or satisfaction rankings regarding doctors and hospitals (48%) and cost information (45%) is used as a resource to help consumers make health care decisions. Academic health sciences centres/teaching hospitals Medical associations/societies Community hospitals Health Canada Pharmacies Provincial Ministries/ Departments of Health Independent health-related websites (e.g., Web MD) Pharmaceutical/biotech/ medical device manufacturers 13% 17% 26% 53% 52% 48% 45% 45% Canadian consumers trust treatment and safety information from academic health sciences centres and medical associations. Least-trusted sources are pharmaceutical, biotech or medical device/product manufacturers, and health insurance companies/ health plans. For information about safe and effective treatments, 53% say they trust academic health sciences centres (53% in 2009) and 52% (53% in 2009) trust medical associations. 48% report they turn to community hospitals, 45% to Health Canada, and 45% to pharmacies (Figure 11). Health insurance companies/health plans Chart shows % who trust the source (i.e., gave a rating of 8, 9, or 10 on a 10-point scale, where 1 = no trust and 10 = complete trust) 2011 Canada 10% 0% 20% 40% 60% 80% 100% 12

13 Generational differences are evident, with Boomers (33%) and Seniors (35%) significantly less trusting of pharmaceutical, biotech, or medical device/product manufacturers than Generation Y (23%) and Generation X (28%). Boomers (18%) and Seniors (27%) are also less trusting of independent medical websites than are Generation Y (11%) and Generation X (11%). For information about treatment costs, consumers turn to medical associations (43%) (46% in 2009) and academic health sciences centres (39%) (42% in 2009). Other trusted sources of cost information include Health Canada (38%), community hospitals (36%), provincial ministries/departments of health (31%), pharmacies (28%), health plans (20%), independent health-related websites (17%), and pharmaceutical/biotech/medical device manufacturers (11%). Few people say they sought information in advance of using a hospital. Of the 18% of consumers who did, most say they were interested in identifying whether the treatment was covered by insurance (8%), others were interested in information on quality or satisfaction ratings (5%), and on hospital services provided (4%). Concern about privacy and security of personal information is high among 30% of consumers, a decline from concerns in Less than one-third of respondents are highly concerned about the security and privacy of personal information shared and stored online, a decline from 34% in 2009 (Figure 12). Use of social media for health care purposes is low among the general population, however is higher among high users of the health system. Consumers say they sought information from social networking sites about prescription drugs (6%), to comment on personal experiences with health care system (4%), and to communicate with an insurance company (3%) or with a physician (1%). Figure 12: Concern about privacy and security of health information How concerned are you that the privacy and security of your personal health/medical information might be at risk if you were to use a computer software program or website to maintain a personal health record that allowed you to share information with your doctor through an Internet connection? 100% 80% 60% 40% 20% 0% 11% 12% 28%/30% 34%/31% 7% 8% 10% 10% Note: Bars may not sum precisely to the totals above due to rounding Canada 2011 Canada 11% 9% 11% 7% 7% 8% Younger generations Generation Y (7%) and Generation X (5%) report they used social networking sites to comment about personal health care experiences; seniors (8%) sought information on prescription drugs. Social media is used as a source of information about prescription drugs by 10% of people with fair to poor health, and by those with one or more chronic conditions (8%). Few people say they blogged about health care in the past 12 months (8%). Those that did commented about their health care experiences (5%), a doctor (3%), or a hospital (2%). 11% 13% 13% 13% 7% 7% 14% 11% Not concerned Concerned 2011 Survey of Health Care Consumers: Canada 13

14 Trust in medical devices to monitor health is high; however with the use of general mobile technologies to monitor health, younger Canadians are interested while interest among older Canadians is low. If their medical records were available via their smart phone or PDA, 15% of consumers say they would be very likely to use telephonic devices for such purposes, 28% would be somewhat likely to use them, and over half of Canadian consumers (57%) would be not at all likely to use their cell phone or PDA to monitor their health (Figure 13). The younger generations are enthusiastic about using their phones or PDAs (25% of Generation Y and 21% of Generation X would definitely use them) or would certainly consider using their phones to monitor health (40% of Generation Y and 34% of Generation X). Men (18% definitely interested and 32% somewhat interested ) are more interested than women (12% definitely interested and 25% somewhat interested ) in using their mobile devices for such purposes. Boomers and Seniors report that they definitely would not make use of their phones or PDAs to monitor health (70% and 77%, respectively). 68% say they would be interested in using a medical device that would check their health condition and send information electronically to their doctor (Figure 13). Interest differs by generation, with 71% of Boomers interested and 60% of Generation Y interested. Adoption of electronic personal health records (PHRs) remains slow, with 7% of consumers maintaining a PHR using a computer software program or a website (6% in 2009); however 66% say they would favor having a government-provided electronic health record (EHR) for use by themselves and their health care providers (61% in 2009). Figure 13: Interest in medical devices and cell phones for health-monitoring purposes If you have or were to develop a health condition that needs to be checked regularly, how interested would you be in using a self-monitoring device? If your medical records were available to you on your smart phone, and you were able to download information about your medical condition and treatments, how likely would you be to use your smart phone to monitor your health? 100% 80% 60% 40% 20% 0% 2011 Canada 68% Interested in using a medical device that would enable you to check your condition and send information to your doctor electronically 15% 28% Likelihood of using a smart phone (or PDA) to monitor health 57% Very likely Somewhat likely Not at all likely 14

15 Zone Three: Traditional health services Physicians 8 in 10 consumers have primary care providers and overall satisfaction is high. Most respondents have a primary care provider (PCP) (84%). Those who do not say they were unable find a physician accepting new patients (50%), felt they didn t need a physician (30%), were unable to locate a physician who could accept a new family group (12%), felt they could not afford to see a physician (8%), or preferred to use alternative health care providers (5%). Over half report they visited their physician in the past year for an illness or injury (52%). Three-fourths of consumers (75%) are satisfied with the care they received from their PCP (Figure 15). 1 in 4 consumers does not seek care or delayed doctor-recommended treatments, primarily because they feel the problem will go away without medical attention. 1 in 4 (26%) people say they chose not to use the health care system at all when sick or injured. This is mostly due to a belief that the problem would go away without medical attention (72%) (Figure 14). Generation Y (79%), in particular, reports believing that medical attention was not necessary. Other consumers report they did not seek care due to time pressures or inconvenient appointment times (39%), cost (5%), and lack of insurance coverage (5%). Inconvenience is an important factor for both Generation X (44%) and Generation Y (41%). 9% of consumers say they decided to either delay or not follow a course of action recommended by their physician. Of these, 44% report they did so because of concern for potential risks or side effects; 25% say they preferred to consult an alternative provider/use natural therapies first or instead. Others decided they no longer needed treatment (21%), did not have time (16%), or did not have insurance coverage (13%); 10% say they did not follow through on treatment because they did not understand what the doctor had recommended. When asked about paying out-of-pocket, consumers identify that cost is an important consideration in delaying or deciding not to follow recommended treatment, with 24% reluctant or unable to pay for treatment for cost reasons. 40% of Generation Y respondents are unwilling to pay costs of health care. Figure 14: Reasons consumers did not see a doctor when they were sick or injured Why did you decide not to see a doctor/medical professional when you were sick or hurt? Thought the problem would go away Appointment times were inconvenient/i did not have time/took too long Wanted to use an alternative approach/natural therapy first or instead Difficult to find a doctor who would accept a new patient Other Cost was too high Insurance did not cover the service or treatment I needed 6% 5% 3% 5% 3% 2009 Canada 2011 Canada 15% 11% 12% 15% 15% 28% 39% 72% 73% 0% 20% 40% 60% 80% 100% Figure 15: Satisfaction with primary care providers and hospitals Overall, how satisfied are you with the quality of care you receive from your primary care provider/received from the hospital you used most recently? 100% 80% 60% 40% 20% 0% 73% 75% Primary care provider Chart shows % giving a rating of 8, 9, or 10 on a 10-point scale (1 = not at all satisfied and 10 = completely satisfied) 2009 Canada 2011 Canada 62% Hospital care 77% 2011 Survey of Health Care Consumers: Canada 15

16 3 in 4 Canadians feel that physician quality of care is high, but many also believe that it varies considerably. Figure 16: Factors important to hospital choice How important were the following factors to you in choosing the hospital you used most recently? The quality of care among physicians is considered to be high by 3 of 4 consumers; however 64% of consumers believe physician quality of care varies considerably. Yet, only 13% of consumers say they compared doctors or medical professionals before choosing one (12% in 2009). A small number (8%) report they switched physicians in the previous year (10% in 2009). Reasons for switching include dissatisfaction with the care provided by the physician (43% as compared to 47% in 2009) or dissatisfaction with the service provided by the clinic staff (21% as compared to 19% in 2009). 22% say they moved locations. Of those who had paid out-of-pocket for physician services in the past 12 months, 38% felt that they had received good value for money; 7% felt the opposite. Distance from home Doctor recommendation/referral Specialization Reputation Insurance coverage Quality/satisfaction ratings or consumer reports Cost of services Amenities Affiliation with a medical school Other Mission to be socially responsible and/or green Affiliation with a religious organization 19% 17% 13% 12% 9% 4% 31% 29% 54% 49% 44% 40% Hospitals Convenience of the location, specialization, and reputation are the primary reasons that Canadian consumers choose specific hospitals. 8 in 10 are satisfied with hospital care, and only 1 in 20 checked hospital quality or satisfaction ratings before using. 38% say they used a hospital service in the preceding 12 months, primarily for outpatient services (26%) and emergency room (ER) treatment (17%). 7% stayed overnight. Almost 8 in 10 (77%) are satisfied with the care they received from a hospital they used recently (Figure 15). Older consumers (88% of Seniors and 79% of Boomers) view their hospital experience more positively than do younger consumers (Generation Y [64%] and Generation X [72%]). Consumers say factors including being close to home (54%), physician recommendation (49%), specialization (44%), and reputation (40%) (Figure 16) influenced their choice of hospital. Those who had not recently used hospital services cite specialization (79%), reputation (70%), and doctor s recommendation (70%) as deciding factors in their hospital choice should they need one. Chart shows % who gave the factor a rating of 8, 9, or 10 on a 10-point scale where 1 = not at all important and 10 = extremely important 2011 Canada 0% 20% 40% 60% 80% 100% Most people are interested in being able to view hospital quality and performance information (37% definitely interested and 50% moderately interested ). 29% say that quality ratings or consumer reports are important factors in hospital selection, yet only 5% actually checked quality or satisfaction ratings prior to using a hospital. Value-added hospital services that are of interest to people if they needed hospital care include same-day outpatient appointments (51%), online appointment scheduling (50%), online access to medical records and tests (48%), and online access to an integrated medical record (46%). Of least interest are assistance with billing inquiries (34%), website with pricing information (30%), and care-coordination assistance (30%). 16

17 Walk-in clinics Canadians are receptive to walk-in clinic options for non-urgent care and will quickly turn to these services if their regular primary care provider is not available. 32% of consumers say they used a walk-in clinic located in a pharmacy or grocery store in the past 12 months for a non-urgent problem. This is the case for Generation Y (36%), Generation X (40%), Boomers (27%), and Seniors (21%). Many are willing to use a walk-in clinic for a minor condition if it meant they would be seen immediately (42%). This is particularly the case for Generation X (48%) and Generation Y (43%). Many Boomers (40%) and 3 in 10 Seniors (30%) also say they would do so. 28% report they would use a walk-in clinic located in a retail outlet rather than a medical office walk-in clinic; this is particularly the case for Generation Y (33%) and Generation X (33%), as compared to Boomers (24%) and Seniors (17%). Few consumers are prepared to pay for care for a minor condition even if it meant that they would receive care more quickly (18%). Approximately 7% report they paid out-of-pocket for care at a private medical or surgical clinic (6% in 2009). Consumers decided to do this to avoid waiting at a publicly funded clinic (43%), to obtain specific treatments (27%), for improved convenience (24%), or because of a perception of superior quality (13%). Traveling for care The majority of consumers say they would leave their local community for care elsewhere if improved quality or faster access were available. Many are open to traveling outside their local area for treatment if recommended to do so by their physician (38%), particularly Seniors (48%). 27% of consumers would not. Only 2% report they traveled outside Canada to consult with a doctor, undergo a medical test or procedure, or receive treatment in the last 12 months, although considerably more say they would consider doing so if they needed a necessary hospital procedure like joint replacement or heart surgery (9% definitely and 46% maybe ) or chose to undertake an elective procedure (7% definitely and 33% maybe ) (Figure 17). Figure 17: Willingness to travel for care How likely would you be to travel for necessary or elective hospital care? 100% 80% 60% 40% 20% 0% Definitely Necessary Elective Necessary Elective Necessary Elective 5% 38% 57% Maybe 47% Go to a hospital that is not the one nearest to your home because it offers better care or faster access to services 12% 11% 41% 43% Highly Unlikely 47% 22% 51% 27% Travel to a hospital outside your town or city (e.g. in a major or different city) which is known to provide better care or faster access to services The decision to travel outside of Canada for necessary care rests upon factors such as an expectation of superior quality medical care and treatment (75%), availability of the specific treatment needed (74%), lack of waiting times (67%), more up-to-date technologies and facilities than available in Canada (66%), and outof-pocket costs involved (64%). With respect to elective procedures such as cosmetic surgery or dental treatments, 41% say they would definitely and 47% would maybe prefer to go to a hospital that is not the one nearest to their home; 27% would definitely and 51% would maybe look outside their local area, and 7% would definitely consider traveling outside of Canada (Figure 17). The decision to travel outside of Canada is based on such criteria as superior quality of medical care and treatment (75%), up-to-date technologies and facilities (72%), availability of the specific treatments (71%), and out-of-pocket costs (70%). 45% 46% 61% 33% 9% 7% Travel outside Canada to have the procedure 2011 Survey of Health Care Consumers: Canada 17

18 Prescription medication use Half of consumers use prescription medications, and 3 in 10 take over-the-counter medications; confidence is high regarding the safety and effectiveness of both brand and generic drugs. Half of respondents (50%) take prescription medication(s), with 41% taking three or more medications. 3 in 10 consumers (27%) are using overthe-counter medications. For people currently taking prescription medication(s), confidence is high regarding the effectiveness of these medication(s) (79% as compared to 71% in 2009). The safety and effectiveness of generic drugs are trusted by many, with 65% trusting them completely. Around 15% of all respondents say they switched to a generic drug to save money in the past 12 months and 11% asked their doctor to prescribe a generic drug based upon cost considerations. 88% of consumers almost always fill their prescriptions as directed. This is particularly true for those with a chronic condition (92%) and for Boomers (90%) and Seniors (96%). Alternative sources of medications are considered based on cost and availability. If faced with starting a prescription medication indefinitely for a chronic condition, 23% say they would purchase prescription medication outside of Canada if they could save 50% or more (18% in 2009). If the respondent had a serious but not life-threatening condition, 36% say they would be prepared to purchase outside of Canada a medication recommended by their physician but not yet available in Canada. 4% say they were treated, or are aware of someone who was treated, in the last 12 months with a personalized medication, which was described as a medicine that is tailored to an individual s needs and condition (e.g., using genetic testing to develop a specialized medication that specifically targets the individual with a particular disease). Of prescription medication users, 15% report they asked their doctor to prescribe a generic drug rather than a brand drug due to cost considerations and 8% say they purchased an over-the-counter product from a store instead of filling a prescription (Figure 18). Figure 18: Prescription medication behaviors motivated by cost Which of the following have you done in the last 12 months? Asked doctor to prescribe a generic drug rather than the brand drug due to cost Purchased an over-the-counter product from a store instead of filling a prescription Asked doctor to prescribe a generic or different drug because prescribed drug was not in insurance plan formulary Purchased a drug using a coupon provided by the pharmaceutical company Purchased prescription medications from a source outside the country Purchased prescription medications from a mail order or online pharmacy Chart shows % of prescription medication users 2011 Canada 2% 1% 3% 8% 7% 15% 0% 20% 40% 60% 80% 100% 18

19 16% of prescription medication users say they switched prescription medications in the past year and 31% asked a pharmacist s opinion about medication prescribed by a doctor or other medical professional. 10% say they modified the dosage or frequency of prescribed medication without telling their doctor and 6% discontinued taking a prescribed medication before it was finished (Figure 19). 58% of prescription medication users report they looked online for information about treatment options or a particular treatment and 28% compared available treatment options for a particular health condition or problem (Figure 19). Figure 19: Non-cost-driven prescription medication behaviors Which of the following have you done in the last 12 months? Looked online for information about treatment options Asked a pharmacist s opinion about a medication that was prescribed by a doctor Compared available treatment options for a particular health condition/problem Asked doctor to prescribe particular drug by name or brand or asked whether it would be a better choice Switched prescription medications 18% 16% 28% 31% 58% Modified the dosage or frequency of prescribed medication without asking or telling your doctor 10% Discontinued taking a prescribed medication before it was finished 6% 0% 20% 40% 60% 80% 100% Chart shows % of prescription medication users 2011 Canada 2011 Survey of Health Care Consumers: Canada 19

20 Zone Four: Alternative health services While Canadians prefer traditional western medicine, 1 in 4 invests in alternative methods. 45% of consumers prefer physicians with an orientation towards traditional medicine whereas 9% have a strong preference for physicians or services that are oriented towards holistic or alternative treatments. 19% say they consulted a herbalist, homeopath, chiropractor, or other alternative practitioner or adviser in the past year (Figure 20). 15% of consumers report that natural or alternative treatments were their first choice in the preceding 12 months and, furthermore, another 6% switched to a health care practitioner who offered alternative treatments or natural therapies. Of prescription medication users, 16% say they used a natural or alternative therapy in addition to a prescribed medication and 6% substituted an alternative therapy for a prescribed medication in the past year (Figure 20). 25% of consumers say they delayed or decided not to follow physician recommendations; instead, they chose to use an alternative treatment or natural therapy first. Figure 20: Use of alternative treatment options and natural therapies Which of the following have you done in the last 12 months? 2011 Canada Treated a health problem with an alternative approach/natural therapy Consulted an herbalist, homeopath, chiropractor, or other alternative health care practitioner or advisor Used an alternative approach/ natural therapy in addition to a prescribed medication (% of medication users) Substituted an alternative approach/natural therapy for a prescribed medication (% of prescription medication users) 6% 16% 19% 26% 0% 20% 40% 60% 20

21 Zone Five: Health insurance Most Canadians believe they are adequately insured across their public and private health insurance. 79% of all respondents are covered by some type of private supplemental health insurance, health plan, or health care program (75% in 2009). Most people have prescription drug coverage (72%), dental (68%), and vision (62%). Reasons for not having supplemental health insurance include losing supplemental insurance after changing employment (24%), cost (18%), and not feeling they need supplemental insurance due to good health status (10%); 8% say they decided that the cost of health care was less than the insurance premium. Health insurance is obtained primarily through employers (82%). 16% purchase insurance directly; men (18%) are more likely to purchase insurance directly than women (13%). 7% obtain insurance through other sources. 37% feel that they are well-insured across their public and private plans (24% in 2009), 55% feel that they are adequately insured, and 7% feel that they are underinsured (Figure 21). Some consumers report that they changed their insurance arrangements in the preceding 12 months (7%). Changes were mainly employment-related; a small number switched companies to get better coverage. Over half of consumers are interested in being able to customize insurance products by selecting benefits and features they valued (57%) rather than selecting from a few pre-packaged insurance products with defined benefits and features (7%). 1 in 4 supports a hypothetical policy option of compulsory supplementary insurance (26%). Regardless of insurance coverage, consumers are concerned about their ability to afford their future health care costs; 3 in 10 spent more on health care than in As in 2009, 39% feel financially well-prepared to handle future health care costs. These people tend to have excellent or very good health status (45%) and feel well-insured. 16% feel less financially prepared to cope with future health care costs. This is particularly true for people who do not have supplemental insurance (27%), feel underinsured (37%), or have fair or poor health status (28%). Figure 21: Adequacy of insurance coverage Thinking about the amount and types of health insurance coverage you have, how adequately insured do you consider yourself to be? 100% 80% 60% 40% 20% 0% 24% 37% Well-insured Percentages are based on respondents who report having private supplemental insurance in addition to provincial or federal insurance (n = 1,752 in 2010 and n = 1,829 in 2011) 2009 Canada 2011 Canada 66% 55% 29% say they experienced an increase in household spending on health care products and services in the past 12 months. The mean increase in expenditure for those who report they experienced an increase in health care spending in past 12 months was 26%. For most (73%), this fell between a one and 30% increase per month; however, for some (11%), this increase was over 70%. Higher increases were experienced by single parents (26%), lower increases by adult households without children (79%). 8% Adequately insured Under-insured Not sure 7% 2% 1% 2011 Survey of Health Care Consumers: Canada 21

22 Zone Six: Health policy Consumers continue to identify health as a major policy issue for federal and provincial governments, focusing on improving access, quality and costs as drivers to improve overall performance; openness to an increased role for private care options is limited. Changes to Canada s health care system are important to consumers, with two-thirds (5% very aware and 61% somewhat aware ) aware of changes in the health care system. Support for changes made to restructure the health care system over the past three to five years differ according to gender, with men (23%) in favor of the changes made and women (15%) uncertain about them. Overall, 21% of consumers are completely supportive of the changes and 7% are not at all supportive. Around 4 in 10 consumers are positive about the Canadian health care system, believing that it is better than many other comparable systems (41%), is of high quality (38%) and is technologically advanced (38%). Generation Y, in particular, is positive when comparing the system s performance to other countries (52%) and the system s quality of care with the rest of the world (44%) (Figure 22). Figure 22: System insights by generation Generation Y ( ) Generation X ( ) Boomers ( ) Seniors ( ) System Insights Agree Disagree Agree Disagree Agree Disagree Agree Disagree Our system works better than most systems in the world. The quality of care in our system is comparable to the best in the world. Physicians and hospitals in our system have access to latest technologies and treatments. The government does a good job balancing priorities in our system. Increased privatization in our system would improve its performance. It is possible to improve quality and reduce costs simultaneously in our current system of care. 52% 4% 39% 7% 39% 7% 40% 8% 44% 7% 37% 11% 35% 12% 39% 11% 39% 5% 32% 9% 37% 8% 49% 6% 24% 13% 15% 21% 12% 25% 15% 21% 25% 28% 22% 27% 20% 33% 25% 32% 46% 5% 48% 8% 51% 8% 44% 9% 22

23 Features of the Canadian system that are appreciated or valued by consumers include up-to-date technology (59%), innovation (51%), modern facilities and equipment (46%), and use of EHRs (43%) (Figure 23). Consumers are critical of the performance of the health care system in such areas as wait times (57%), access (28%), wellness-orientation (26%), use of EHR (22%), and patient-orientation (22%) (Figure 23). Opinion is mixed concerning privatization: around 1 in 5 (22%) believes that privatization would improve performance whereas one-third does not (30%). Boomers are not enthusiastic about privatization (33%) and 40% of consumers with three or more chronic conditions are not convinced that privatization is the solution for improved performance. Health care is an important policy issue. 67% believe that it is an important federal electoral issue and 73% indicate that it will be important in the next provincial elections. Future policy priorities include increasing access (72%), improving quality (68%), reducing costs (58%), public-private service mix (53%), and increasing private care options (33%). Figure 23: Report card grades for specific elements of the health care system How would you grade the Canadian health system on the following dimensions (using a typical report card scale of A, B, C, D, and F)? Up-to-date technology Medical innovation (new treatments or services) Up-to-date buildings and equipment Use of electronic health records (EHRs) Patient-/consumer-oriented Access to services (availability and convenience) Focus on wellness rather than illness Wait times for service 8% 13% 15% 14% 22% 22% 33% 28% 30% 26% 35% 43% 46% 51% 57% 59% 0% 20% 40% 60% 80% 100% Favorable grade ( A or B ) Unfavorable grade ( D or F ) 2011 Survey of Health Care Consumers: Canada 23