After a ‘decade of decline’ in health care, Canadians not convinced that money is enough to solve the crisis

Canadians prioritize keeping ERs open, credentialling foreign doctors, in pursuit of better outcomes

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August 17, 2023 – Billions of dollars will be injected into Canada’s ailing health care system over the next decade. And while money is certainly a variable in the equation that will lead to better outcomes, Canadians and health care professionals alike see structural issues that suggest money isn’t a cure-all.

A new study from the non-profit Angus Reid Institute, in partnership with the Canadian Medical Association, finds a majority (60%) of Canadians believe the $46.2-billion injection of funds agreed to by the federal government earlier this year will improve the health care system, but that the vast majority in this group (51%) believe the gains will be at best marginal. By contrast, two-thirds of Canadians (66%) think there are structural problems within health care that surmount a lack of funding.

Among these concerns is evidently a desire to streamline the ability to practice as a physician in Canada. As the country faces a doctor shortage, three-in-five (62%) want to make it easier for foreign doctors to secure the right to practice in this country to help increase the pool of physicians in Canada.

This research also includes the opinions of Canadians who work in the health care field, including doctors, nurses and other primary care practitioners. Those within the health care system are more optimistic that more money can fix challenges in health care (40%) than those without (33%), but that still leaves a majority who think there are greater issues that money can’t solve (60%).

Meanwhile, most Canadians believe health care has worsened in the country over the last decade. Currently, 68 per cent of Canadians believe this, an increase from the 42 per cent who said the same in 2015.

As provincial governments look for solutions to fix a health care system that has consistently been described as “in crisis” in the post-pandemic era, there are some wounds Canadians prioritize suturing first over others. Ensuring emergency departments are adequately staffed to avoid closures is a top three priority for two-in-five (43%). Reducing the mental health strain on health care workers also ranks highly among potential fixes to the system (31%). Increasing the speed of treatment, from diagnosis to resolution (33%), and reducing wait lists for family doctors (27%) and surgeries (31%) are also key in the eyes of Canadians.

All this comes as many struggle to access the ailing health care system. The Angus Reid Institute’s Health Care Access Index, first created one year ago, finds three-in-ten (29%) facing Chronic Difficulty accessing the health care they say they need. One-in-three (34%) are facing fewer, but still some, barriers, while just one-in-six (16%) have little trouble with finding and receiving care from Canada’s health system.

More Key Findings:

• Half of Canadians either don’t have a family doctor (19%) or struggle to see the one they have (29%).

• Persistent problems in the health care system have left seven-in-ten (68%) pessimistic there will be improvements to the system in the next two years and more than half (56%) doubtful things will change for the better even five years down the line.

• Those who believe their province does a poor or terrible job measuring health care performance (68%) significantly outnumber those who instead believe their provincial government is doing great or good on this front (24%). Two-thirds (67%) believe health care performance would be improved by their province making key health care performance indicators publicly available.

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.

About CMA

The Canadian Medical Association (CMA) is leading a national movement of physicians who believe in a better future of health. CMA’s goal is a more sustainable, accessible health system — more urgently needed than ever — and a new culture of medicine that champions equity, diversity and inclusion.

Note: Because its small population precludes drawing discrete samples over multiple waves, data on Prince Edward Island is not released.

INDEX

Part One: The state of health care

• Most Canadians say quality of health care has plummeted over last decade

• Satisfaction levels drop across the country

• Are governments prioritizing health care enough?

Part Two: Measuring access

• Half say they don’t have a GP or it’s difficult to get an appointment with the one they have

• Persistent challenges to care

• Health Care Access Index

• Access as a key driver of satisfaction

Part Three: What will “heal” the system?

• Is money the cure?

  • Two-thirds say issues are more structural

• Allow more foreign-trained doctors to practice

• Priorities focus on timely access and health of workers

  • What would health care workers prioritize?

• A place for private care if provinces direct funds?

• Better measurement needed

Part Four: Hope for the future

 

Part One: The state of health care

As Canada emerged from the public health emergency caused by the COVID-19 pandemic, it became clear another was simmering below the surface. The health care system was, and still is, in “crisis”, as multiple issues plague health care, shaking confidence in an institution that was once a point of national pride. There are staff shortages among key health care work forces, surgery backlogs and a lack of family doctors, leaving governments across the country scrambling to find solutions.

The federal and provincial governments came together to agree to the framework of a funding boost for the province-run health care systems, but it remains to be seen if it will be enough to solve the multi-faceted problems troubling health care in the country.

Related:

• Funding Faceoff: Canadians split over key decisions regarding federal-provincial Health Accord
• Public Purists, Privatization Proponents and the Curious: Canada’s three health care mindsets

Most Canadians say quality of health care has plummeted over last decade

A majority of Canadians believe the health care system has crumbled in the last decade. Approaching seven-in-ten (68%) say the overall quality of health care in Canada has “deteriorated” in the last 10 or 15 years, while one-quarter (24%) believe it has remained consistent. Fewer than one-in-ten (8%) believe there has been improvement over the past 10 years.

When the Angus Reid Institute last asked this question in 2015, nearly as many Canadians believed the health care system had at least held steady (42%) as deteriorated (42%). Now, the ranks of those who see a worsening public health care has grown by 26 percentage points:

Satisfaction levels drop across the country

Stewardship of Canada’s health care system falls to the provinces, who are responsible for administering health care within their borders. However, the federal government also has a role in funding health care across the country through the Canada Health Transfer.

Since 2015, both levels of government are more likely to be viewed critically by Canadians when it comes to their record on public health. Eight years ago, in data taken prior to the election of the Liberals in their first majority government under Prime Minister Justin Trudeau, approaching half of Canadians said they were satisfied with the performance of both the federal (45%) and their provincial (45%) government on health care. Since then, every provincial government except Saskatchewan and Newfoundland and Labrador has changed governing parties at least once, as the level of satisfaction with both levels of government has declined to three-in-ten:

Those who live in Saskatchewan (37%), Quebec (37%) and Alberta (36%) are most likely to be satisfied with the performance of their provincial government on health care. However, in all regions across the country satisfaction is below two-in-five. Those who live in Manitoba (21%) and New Brunswick (18%) are more critical of their provincial government on this file than others. In general, satisfaction is low in Atlantic Canada:

Are governments prioritizing health care enough?

Most Canadians believe both levels of government are not focusing enough on the issue of health care. Fewer than one-in-five believe either the federal government (16%) or their provincial government (18%) have prioritized fixing health care enough. Instead, a majority say both levels of government need to do more. Others go further: one-quarter, in the case of the federal government, and three-in-ten (31%), in the case of their provincial government, believe lawmakers at those levels aren’t making health care a priority at all (see detailed tables).

Though past Liberal voters are more likely (27%) than other political supporters to believe the federal government has put enough emphasis on addressing health care, the prevailing sentiment across party lines is that not enough is being done by the federal Liberal government on the health care file. Two-in-five (40%) of those who voted Conservative in 2021, and three-in-ten (31%) of those who voted Bloc Québécois, believe the federal government is not prioritizing the issue at all:

Three-in-ten (28%) in Alberta say the UCP government is prioritizing health care enough, the most in the country. Still, the majority sense there, as well as elsewhere in the country, is the provincial government needs to pay more attention to the issue. This is particularly the case in Ontario, Quebec, and Manitoba, where the incumbent government faces re-election this fall:

Part Two: Measuring access

Half say they don’t have a GP or it’s difficult to get an appointment with the one they have

Family doctors often provide the first point of access for Canadians into the health care system, but there has been a growing shortage of physicians to fill this key role.

As it stands, one-in-five (19%) Canadians say they don’t have a family doctor, a similar proportion who told the Angus Reid Institute this 12 months ago. Even for those who do have a general practitioner, or GP, access can be a challenge. A further three-in-ten (29%) say it’s difficult to get an appointment with the GP they have. Approaching two-in-five (37%) say it usually takes a few days to get an appointment with their family doctor, while one-in-six (15%) say they get in right away whenever they need to see their doctor.

This experience is inconsistent across the country. In Ontario, 13 per cent say they don’t have a family doctor, the fewest in the country. Across the border in Quebec, there are twice as many (26%) who say they the same. Meanwhile, access to a family doctor appears to be a significant problem in Atlantic Canada, where at least three-in-five in New Brunswick (61%), Nova Scotia (67%) and Newfoundland and Labrador (58%) say either they don’t have a family doctor or it’s difficult to get an appointment with the one they have.

Recent immigrants to Canada are much less likely to have a family doctor than others who are more established in the country. More than two-in-five (44%) who have been in Canada for less than five years say they do not have a family doctor. Fewer than one-in-six (14%) who have been in the country for longer than two decades say the same:

Persistent challenges to care

There are one-in-six (15%) who say they don’t want or need a family doctor, led by one-quarter (26%) of men under the age of 35. But for many others, the search to find a family doctor has been fruitless. Overall, two-in-five (38%) Canadians who don’t have a family doctor say they have been searching for one for more than a year, while a further one-quarter (26%) have given up their search entirely:

There appear to be more struggles for Canadians who identify as LGBTQ2+ to find family doctors than those who do not identify as such. Three-quarters (75%) of Canadians who identify as LGBTQ2+ do have a family doctor, though this is a lower rate than those who don’t identify as a member of the LGBTQ2+ community (82%).

One-in-ten (9%) members of the LGBTQ2+ community say they’ve been looking for a GP for more than a year, while a further one-in-12 (8%) say they’ve given up on finding one for now. Some LGBTQ2+ advocates report members of the community find barriers to health care and often struggle to find family doctors who understand LGBTQ2+ issues:

Canadians who identify as visible minorities are also less likely to have a family doctor (77%) than those who don’t identify as such (83%). They are also nearly twice as likely to have given up finding a family doctor (7%) than Canadians who don’t identify as visible minorities (4%):

Most Canadians say they have required some sort of medical care in the past six months, including non-emergency treatment (63% needed this), an appointment with a specialist (38%), a diagnostic test (37%), a visit to the emergency room (15%) or surgery (7%, see detailed tables).

Access to this required care has been challenging for many. At least two-in-five who required each type of medical care in recent months say it was either difficult, very difficult or impossible to get the care they needed from the health care system. Canadians report the most difficulty in seeing a specialist, with a majority (54%) describing it as difficult to obtain an appointment with one and six per cent saying it was impossible.

There have been some modest improvements on some points of access in the last 12 months. Canadians are less likely to say receiving non-emergency treatment, surgery and emergency care was difficult than they were last year at this time. However, the number of Canadians reporting challenges accessing health care remain at high levels:

Health Care Access Index

To understand and monitor the varied experiences of Canadians over the past six months, Angus Reid Institute researchers utilized the Health Care Access Index, first introduced last year. This index uses a scoring mechanism to categorize respondents into one of four groups. One of these groups – 21 per cent of Canadians overall – is simply made up of those who have not needed to access care over the past six months. The other three groups are scored based on their interactions with various levels of care. Broadly, positive interactions with health care – accessing health care services or a doctor’s appointment easily – are scored positively and negative interactions – having a difficult time accessing care – are scored negatively. For full details on how the Index was scored, please click here.

Using this Index, Canadians who needed health care recently fall into one of three groups: those with Comfortable Access, Some Challenges, or Chronic Difficulty in securing adequate care.

What is notable about this iteration is that the Comfortable Access group remains of a similar size, though the number of those seeking care has contributed to an increase in those with Some Challenges in access. Perhaps most notable, however, is the persistence of challenges, six months after the announcement of a $46-billion funding agreement between the federal government and the provinces and territories:

Access is a challenge everywhere in the country. Those reporting Comfortable Access are most concentrated in Alberta and Ontario. The highest levels of obstacles encountered are reported in Atlantic Canada, which continues a long-chronicled struggle to improve care for a comparatively more aged population:

New Canadians appear to be struggling to access the health care system in their adopted country. Half (48%) of immigrants who have been in Canada for five years or less fall into the Chronic Difficulty category. Overall, those who were born in Canada are more likely to have Comfortable Access (17%) and less likely to report Chronic Difficulty (28%) than those who were born elsewhere (13% and 34% respectively):

Access also appears to be an elevated challenge for Canadians who identify as LGBTQ2+. Among this group, the percentage noting Comfortable Access drops compared to other Canadians, and three-quarters (73%) voice challenges compared to 61 per cent among the non LGBTQ2+ group:

Access as a key driver of satisfaction

Canadians who have encountered few challenges in their access to the health care system in recent months are much more likely to be satisfied with their provincial government’s performance on the issue. Approaching half (47%) of those in the Comfortable Access category say they are happy with their province’s work on the health care file. Comparatively, one-in-five (18%) who have had Chronic Difficult to get the care they say they needed applaud their provincial government’s efforts on health care.

Notably, however, even those with Comfortable Access are more critical (53%) than not (47%):

Part Three: What will “heal” the system?

Given the overwhelming sense that health care in Canada is in a diminished state post-pandemic, and certainly compared to sentiments measured in 2015, the pertinent question becomes “what now?”.

Is money the cure?

Earlier this year, the federal government and provincial governments reached an agreement on a boost to health care funding from the federal government including a top-up of the Canada Health Transfer. The increase in funds amounts to an estimated $46.2 billion over the next decade. The provinces negotiated individual deals with the federal government on how this money would be used, though Quebec remains as the lone holdout from the health care funding boost.

A majority of Canadians believe this new funding will improve the health care system. However, few – one-in-ten (9%) – believe it will be a panacea. Half (51%) believe the additional money will have marginal benefits. Three-in-ten (31%) are more pessimistic and believe the funding boost will have no effect whatsoever. Those in Alberta (37%), Saskatchewan (37%), Quebec (35%) and New Brunswick (35%) are the least optimistic there will be improvements from this cash injection into health care (see detailed tables).

There is also less optimism the additional health care funding will patch-up the battered system among those who have faced Chronic Difficulty accessing it. Half (47%) in that group believe the improvements will come along the margins, while two-in-five (37%) say there will be no improvements in health care at all despite the additional funds. Those who already have Comfortable Access to health care services are the most likely to believe health care will improve greatly from this additional federal money:

From within the system itself, there is a greater sense that there will be improvements from additional cash transfers to health care from the federal government. Among those who say they work in health care in a primary role – including nurses, doctors, medical technologists, paramedics, occupational therapists and pharmacists – one-in-five (18%) believe the additional federal funding will greatly improve the health care system. Still, there are more health care workers (26%) who believe no improvements will come after the funding injection. And half of those within (49%) and outside of (51%) health care believe the improvements will only be slight:

Two-thirds say issues are more structural

While increased funding is undoubtedly an element of improving care in Canada, there is a sense among Canadians that more must be done at the structural level. Young people are most likely to say that these issues could be overcome with enough money injected into the right places (see detailed tables), but overall, a firm majority of Canadians say that there are bigger challenges that money will not fix. This sense is most profound in Alberta and Atlantic Canada:

Among those within the health care system, a majority (60%) believe there are bigger problems that more money can’t fix. Still, health care workers (40%) are more likely than those who don’t work in health care (33%) to believe more investment in the system would cure what ails public health care:

Allow more foreign-trained doctors to practice

One of those issues that Canada must overcome is a persistent doctor shortage, which is expected to worsen in the coming years. Canadians were asked what they would do to address this problem. For many, the answers are found in licensing issues. Most Canadians say that making it easier for foreign doctors to become credentialled to practice in Canada would be a productive way to go about this, though it is worth noting that enthusiasm for this is much lower among health care workers. Nonetheless, it is the top option for both groups. Many also say that unifying licensing across provincial boundaries would help, allowing doctors to practice in different parts of the country. Those in health care stand out as being more enthusiastic about increasing university and college programs for medical students:

Priorities focus on timely access and health of workers

In terms of the priorities they would like to see addressed, Canadians find some agreement about what should be done to improve the health care system. Respondents were given a list of 13 different priorities and asked which they would prefer to focus on for health care delivery in their own province. Respondents were first asked about each of the potential improvements and then asked to rank the priorities they chose as “must haves” (see questionnaire).

Below is a summary of the highest selected responses based on the top choice, top two choices, and top three choices that Canadians make for their province (see the full list of priorities in the detailed tables). The significance of timeliness and access are notable throughout:

Those who struggle most to access care in Canada show a higher level of priority for emergency departments and quick patient treatment. Canadians in each group tend to have similar levels of emphasis, however, for each priority (see detailed tables).

What would health care workers prioritize?

For those currently working in health care, the top priority is ensuring the mental and physical health of the work force after years of pandemic pressure. Emergency departments are also a key priority. However, this group is less focused on surgery wait times than the general population.

A place for private care if provinces direct funds?

Debates about privatization of health care have become louder in some jurisdictions of the country over the past few years. In Ontario, the government passed a bill earlier this year that would allow private clinics to conduct more surgeries in order to clear the province’s backlog. In Quebec, the government recently pushed in the opposite direction, announcing plans to limit the use of private health agencies starting next year. In Alberta, Danielle Smith backtracked on comments that previously supported privatizing some hospital operations, and stated that her party would, however, continue contracting surgeries to private clinics.

These ongoing events mirror Canadian views of privatization, with large groups taking positions on each side of the debate. Three-in-ten Canadians (31%) say that more private care would improve health care, while 44 per cent say it would worsen the situation. Notably, the percentage of Canadians who are “unsure” how they feel about this has increased seven points since last year, with a subsequent drop in those holding a negative view.

Those who have Comfortable Access and those who face Chronic Difficulty in receiving care both hold similar views. In each group 46 per cent say more private care would worsen the health care in Canada (see detailed tables).

In some ways, support for private care depends on who is involved. Canadians are generally comfortable with provincial governments contracting out care if it helps to speed up the process and clear backlogs. That said, support drops from 56 per cent to 38 per cent when the proposal is framed as having patients pay for care themselves:

Better measurement needed

A key aspect of health care improvement in any system is measurement and response. A report from Ontario Health outlined this imperative just last year, noting that a “sustainable health system requires a learning health data ecosystem that depends on high-quality, timely, and integrated health data.” Many provinces struggle with modernizing and synthesizing data measurement, and Canadians are overwhelmingly of the view that their province is doing a poor job on this file:

While those working in health care are more likely to offer praise, the majority view remains critical – three-in-five (61%) in health care say their province does a “poor” or “terrible” job measuring how health care is delivered (see detailed tables).

This dissatisfaction is compounded by the sense that improving measurement would leave to positive outcomes. While one-in-three (33%) say that more integration and efficiency in reporting will not make much of a difference, the rest feel that there are gains to be had:

Part Four: Hope for the future

The problems facing the health care system are complex and may take years to sort out. The majority of Canadians are pessimistic that the health care system will not improve in the next two (68%) or five (56%) years, but there is more optimism that improvements will occur over the longer time frame.

Men are more likely than women to be optimistic on this front, including more than two-in-five (44%) men over the age of 54 who say they believe the health care system will improve in the next five years. Still, for all demographics, at least half are more pessimistic than optimistic (see detailed tables).

Two-in-five (43%) of those who voted Liberal in 2021 are optimistic there will be improvements to health care in the next five years, the most of any group of past voters. Past NDP voters are the least likely to be optimistic that there will be improvements in the next two (17%) or five years (32%, see detailed tables).

Difficulty accessing the health care system appears to be a driving factor in whether Canadians believe there is a brighter future ahead for health care. Those who report encountering barriers to health care access in recent months are less optimistic there will be improvements to health care in either two (17%) or five (27%) years than those who have had an easier time receiving the care they say they’ve needed:

Survey Methodology:

The Angus Reid Institute and the Canadian Medical Association conducted an online survey from Aug. 1-8, 2023 among a representative randomized sample of 5,010 Canadian adults who are members of Angus Reid Forum. For comparison purposes only, a probability sample of this size would carry a margin of error of +/- 1 percentage points, 19 times out of 20. Discrepancies in or between totals are due to rounding. The survey was self-commissioned and paid for jointly by ARI and CMA.

For detailed results by age, gender, region, education, and other demographics, click here. 

For detailed results by whether or not respondents identify as LGBTQ2+, or whether they are health care workers, click here.

For detailed results by the Health Care Access Index, click here

For detailed results by how long the respondent has been in Canada, click here.

To read the full report, including detailed tables and methodology, click here. 

To read the questionnaire, click here.

Image – Hush Naidoo Jade Photography/Unsplash

MEDIA CONTACT:

Shachi Kurl, President, ARI: 604.908.1693 shachi.kurl@angusreid.org @shachikurl

Elena Gabrysz, Senior Advisor, Media Relations, CMA: 514.839.7296 elena.gabrysz@cma.ca

Eric Lewis, Senior Advisor, Media Relations, CMA: 506.566.1671 eric.lewis@cma.ca

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