Access to health care a significant problem for one-in-five Canadians 55 and older

by David Korzinski | August 6, 2019 10:30 pm

Twice as many say their province’s health care system has ‘deteriorated’ as say it has improved


August 7, 2019 – As the 2019 federal election campaign approaches and parties begin making their pitches to voters, a new public opinion poll from the non-profit Angus Reid Institute suggests there is ample room for policy platforms based on improving health care delivery for Canada’s aging population.

The study finds more than 2 million Canadians aged 55 and older face significant barriers when accessing the health care system in their province, such as being unable to find a family doctor or experiencing lengthy wait-times for surgery, diagnostic tests, or specialist visits.

Moreover, most Canadians in this age group have at least some difficulty getting the care they want or need in a timely manner.

The study focuses on the health care experiences of older Canadians, as well as their assessments of the quality of care they receive.

Most Canadians this age take a positive view of their own health care, but they are more skeptical in their assessments of the trajectory of care in their provinces. The perception that health care in their home province has “deteriorated” over the last 10 to 15 years outpaces the view that it has improved in every region of the country except Saskatchewan.

Indeed, while barriers to health care exist for Canadians 55 and older in every province, the problem is most acute in Atlantic Canada, where provincial systems are often swamped by growing demand[1] from their aging populations.

 

More Key Findings:

 

About ARI

The Angus Reid Institute (ARI) was founded in October 2014 by pollster and sociologist, Dr. Angus Reid. ARI is a national, not-for-profit, non-partisan public opinion research foundation established to advance education by commissioning, conducting and disseminating to the public accessible and impartial statistical data, research and policy analysis on economics, political science, philanthropy, public administration, domestic and international affairs and other socio-economic issues of importance to Canada and its world.

 

INDEX:

Part 1: Measuring access issues

Part 2: Assessing system quality

Part 3: Notes on methodology

 

Part 1: Measuring access issues

Introduction: A holistic approach to the system

In recent years, Angus Reid Institute studies have looked at access to primary care[2], wait times for orthopedic surgery[3], prescription drug access[4] and pharmacare, among other health topics[5]. The goal of this study was to take a holistic approach to the health care system while focusing on those people who use it most: aging Baby Boomers and older Canadians.

The survey asked questions about primary care, medical specialists, advanced diagnostic tests, surgery, and prescription drugs, with the goal of canvassing the totality of a person’s interactions with the health care system where they live.

Combining respondents’ experiences with both primary and specialty care, this study groups people ages 55 and older into three categories: Those who have no trouble accessing the health care system in their province (“no access issues,” 31% of the population), those who have some trouble (“moderate access issues,” 48%) and those who have a lot of trouble (“major access issues,” 21%).

These three groups will be discussed in greater detail later in this section, and a technical description of how the groups were derived can be found in the “Notes on methodology” section at the end of this report.

Primary care: how easy is it to see your doctor?

In order to talk about access to the health care system, it’s helpful to begin with primary care. The vast majority of Canadians of all ages have a family doctor, including fully 19-in-20 older Canadians (96% of the 55-plus age group). That said, as the Angus Reid Institute found in 2015[6], simply having a family doctor is not the same as being able to get the primary care you want or need.

Respondents who indicated they have a family doctor were asked a follow-up question about how easy it is to get an appointment with that doctor if something comes up:

Thus, the overall landscape of primary care among Baby Boomers and seniors in Canada can be described in terms of the five overall groups shown in the graph that follows, which ARI first described in the 2015 study.

Those who say it’s easy to see their doctor make up the “easy access” group, those who say they have to wait at least a few days are considered to have “acceptable access,” and those who say it is difficult to get in to see their doctors make up the “difficult access” group. Those described in the graph as “no access” are respondents who don’t have a family doctor, but are looking for one, while those described as “not interested” are respondents who don’t have one and aren’t looking.

These totals are essentially unchanged from where they were among those ages 55 and older in 2015.

Notably, the 2015 study found that access was correlated with age. Those under 55 were more likely to be in the “difficult” or “no access” groups, while those in older age brackets tended to find themselves in the “easy” or “acceptable access” groups.

This study finds a similar pattern within the 55-plus age group. Those ages 75 and older are more likely to have easy or acceptable access to primary care, while those ages 55-64 are more likely to have no access or difficult access.

Specialists, tests, and surgeries

The family doctor may be the most common point of contact Canadians have with their provincial health care systems, but it is far from the only one. This survey asked about eight ways in which a person might have interacted with the health care system in the last year:

It’s notable that the oldest Canadians (those ages 75 and older) are more likely than younger ones to have had each of the experiences on the list over the last 12 months, with the exception of visiting a walk-in clinic:

Respondents who visited a medical specialist, received an advanced diagnostic test, or had surgery – as well as those who indicated on a separate question that they needed these procedures but hadn’t received them yet – were asked follow-up questions about their time spent waiting for each.

As with primary care, most older Canadians who needed an advanced diagnostic test, a medical specialist, or surgery report relatively easy access to the procedure, with significant majorities waiting less than six months for each of the three.

That said, one-in-three who needed surgery waited longer than six months (the federal benchmark[7] for hip and knee replacements), while significant numbers also waited this long for diagnostic tests or to simply see a specialist:

One-in-five have major access issues

Combining these two considerations – primary and specialized care – yields the aforementioned three groups, as seen in the graph that follows.

There are a variety of ways in which a respondent can end up in each of these three groups, but in general, the follow descriptions of each group apply:

Full details on the methodology used can be found in the “Notes on methodology” section at the end of this report.

Looking at the size of these three groups across different age categories, an interesting pattern emerges: The oldest Canadians are less likely to have “no access issues,” but they’re also less likely to have major ones. Instead, a full majority of those ages 75 and older (56%) find themselves in the “moderate access issues” group, a finding that likely reflects their more frequent use of the system, overall:

Indeed, use of the system is highly correlated with access issues. Those who use the system less frequently are less likely to report having problems accessing it, while heavy users are disproportionately represented in the “major access issues” group. For an explanation of how the usage groups in the following graph were derived, see “Notes on methodology” at the end of this report.

Regionally, Atlantic Canada has the highest proportion of older residents with major access issues, 10 percentage points higher than the next highest proportion, in Quebec.

This finding likely reflects the longstanding doctor shortage[8] in the Atlantic provinces, a problem that – coupled with an aging population – has been described as “a ticking time bomb[9]” in the region.

Part 2: Assessing system quality

Most rate the care they receive as good

Despite substantial problems with access, most aging Canadians rate the health care they receive in their province as “good” or “very good.”

This holds true across each of seven areas of interaction canvassed in this survey. Respondents who indicated they had done each of these activities were asked a follow-up question about how they would rate the quality of the care they received. For each one, the vast majority of those 55+ describe the care they received favourably.

Even emergency room visits for primary care (i.e. non-emergency reasons), which are viewed most negatively, still receive a “good” or “very good” rating from eight-in-ten who made such a visit.

Assessments of each experience are summarized in the graph that follows.

Looking at this data another way, respondents can be grouped into a few broad categories:

Access issues are highly correlated with bad experiences with the system. Only 6 per cent of those who have “no access issues” had a health care experience in the last year that they would describe as “poor.” This proportion rises to roughly one-in-seven (14%) among those with moderate access issues, and fully one-in-three (34%) among those with major ones:

A similar picture emerges from a question about respondents’ overall assessments of the health care they receive where they live. Quebec and Atlantic residents are notably less likely to choose “very good” and more likely to choose poor or very poor, though large majorities even in these regions still view their provincial systems favourably:

Indeed, even those with major access issues say the care they are able to receive is good, though it’s notable they’re about half as likely as those in other groups to rate their overall care as “very good”:

Few see the system as improving

While most Canadians in the 55-plus category hold positive views of the health care they personally receive, they feel less sanguine about the quality of the system overall.

Asked whether health care in their province has been improving or deteriorating over the last decade or so, twice as many choose the latter (37%) as choose the former (18%). The rest (45%) place themselves in the middle, saying overall system quality has stayed the same.

Again, Atlantic residents stand out in their displeasure. Nearly two-in-three (65%) Atlantic Canadians aged 55 or older say the health care system in their province has deteriorated over the last 10 to 15 years.

Residents of other regions tend to be more mixed in their responses to this question, though the perception that the system has worsened outpaces the perception that it has improved in every province except Saskatchewan:

On this question, those with major access issues are outliers. While this group generally has a positive view of the care they receive, half (51%) perceive the system in their province as deteriorating, compared to about one-in-three among those with greater access to health care:

Part 3: Notes on Methodology

System Access Index

In order to measure overall access to the health care system among Canadians, Angus Reid Institute researchers combined respondents’ answers to questions about primary care, medical specialists, advanced diagnostic tests, and surgical procedures, assigning each response a value in points. The three groups that make up the System Access Index – those with “no issues,” “moderate issues,” and “major issues” – are derived by adding up a respondents’ total accumulated points and grouping them with those achieving similar scores.

Points were awarded to respondents in the following manner:

This creates a scale with a minimum score of 0 and a maximum score of 12, with most respondents registering on the lower end.

The group referred to in this report as having “no access issues” are those who score a 0 or a 1 on this scale. Those scoring a 2 or a 3 are considered to have “moderate access issues.” By definition, members of this group must either have difficult access to primary care, a wait time longer than six months for a test, specialist, or surgery, or multiple shorter waits and “acceptable access” to primary care.

Finally, those scoring a 4 or higher are considered to have “major access issues.” Mathematically, this group must have either difficult or non-existent access to primary care and a notable wait time for a specialist, test, or surgery, or they must have multiple wait times longer than six months, with acceptable or better access to primary care.

System Usage Index

Using similar methodology, ARI researchers also scored respondents based on their usage of the system. Specifically, researchers assigned points to respondents’ answers to the question: “In the last year, how often, if at all, have you done each of the following?” Eight items were listed, and respondents could indicate that they had done each one “never,” “once,” “2-3 times,” “4-5 times,” or “6+ times.” The items listed were:

The first three items on the list (visited a family doctor, walk-in clinic, or emergency room for primary care) were scored according to the following scale: 0 points for “never,” 1 point for “once,” 2 points for “2-3 times,” 3 points for “4-5 times,” and 4 points for “6+ times.”

The next three items (visited an emergency room for an emergency, visited a medical specialist, and received an advanced diagnostic test) are considered more serious uses of the health care system, and were awarded double points in comparison to the first three items. For these three, scores were 0 points for “never,” 2 points for “once,” 4 points for “2-3 times,” 6 points for “4-5 times,” and 8 points for “6+ times.”

The final two items on the list (surgery and overnight hospital visits) are considered especially serious, and were given triple points: 0 points for “never,” 3 points for “once,” 6 points for “2-3 times,” 9 points for “4-5 times,” and 12 points for “6+ times.”

This creates a scale with a minimum score of 0 and a maximum score of 60, with most respondents registering on the lower end.

For the purposes of this report, those scoring 0 to 6 on the scale (50% of all respondents ages 55 and older) are considered “light users,” those scoring a 7 – 12 (27% of) are considered “moderate users,” and those scoring 13 or higher (23%) are considered “heavy users” of the health care system.

For detailed results by age, gender, region, education, and other demographics, click here[10]

For detailed results by System Access Index, click here[11]

Click here for the full report, including summary tables and methodology[12]

Click here for the full questionnaire used in this survey[13]


MEDIA CONTACTS:

Shachi Kurl, Executive Director: 604.908.1693 shachi.kurl@angusreid.org[14] @shachikurl

Dave Korzinski, Research Associate: 250.899.0821 dave.korzinski@angusreid.org[15]

Endnotes:
  1. growing demand: https://www.cbc.ca/news/canada/nova-scotia/atlantic-canada-health-care-time-bomb-1.3827288
  2. access to primary care: http://angusreid.org/health-care-analysis/
  3. orthopedic surgery: http://angusreid.org/orthopedic-surgery/
  4. prescription drug access: http://angusreid.org/prescription-drugs-canada/
  5. other health topics: http://angusreid.org/category/health/
  6. in 2015: http://angusreid.org/health-care-analysis/
  7. the federal benchmark: http://waittimes.cihi.ca/All#year
  8. longstanding doctor shortage: https://globalnews.ca/news/4898381/atlantic-canada-regional-health-licensing/
  9. a ticking time bomb: https://www.cbc.ca/news/canada/nova-scotia/atlantic-canada-health-care-time-bomb-1.3827288
  10. here: http://angusreid.org/wp-content/uploads/2019/05/2019.05.30_Senior-Health_Demo-Release-Tables.pdf
  11. here: http://angusreid.org/wp-content/uploads/2019/05/2019.05.31_Senior-Health_System-Access-Index-Release-Tables.pdf
  12. Click here for the full report, including summary tables and methodology: http://angusreid.org/wp-content/uploads/2019/08/2019.08.07_Senior-Health-I.pdf
  13. Click here for the full questionnaire used in this survey: http://angusreid.org/wp-content/uploads/2019/08/2019.08.07_SeniorHealth_Questionnaire-Press-Release.pdf
  14. shachi.kurl@angusreid.org: mailto:shachi.kurl@angusreid.org
  15. dave.korzinski@angusreid.org: mailto:dave.korzinski@angusreid.org

Source URL: http://angusreid.org/senior-health-access/