Are Canadians too satisfied with their health care system?

Canadians are proud of Medicare and consistently report being satisfied with the health care services they receive. But, perhaps they should be demanding better.

The most recent Health Council of Canada report highlights findings from the 2012 Commonwealth Fund survey of primary care physicians in 10 high income countries. In almost all areas – from access to care coordination to use of information technology – Canada ranks at or near the bottom.

Canada’s poor performance relative to other countries shouldn’t be too surprising. After all, Canada ranked at or near the bottom in a similar survey from 2009. What did surprise me, though, was the considerable variation in quality of primary care between provinces.

Results from Quebec were consistently far below the Canadian national average. Only 22% of Quebec primary care physicians report that their patients can get same or next day appointments compared to the Canadian average of 47% (the lowest national average among all countries). Only 8% of Quebec physicians said they are notified when their patients go the emergency department compared to the Canadian average of 30%.  And only 26% of Quebec physicians said they use electronic medical records compared to the Canadian average of 57% (the second lowest national average among all countries).

In contrast, physicians in Ontario, BC, and Nova Scotia all reported better same or next day access than the Canadian average. Ontario physicians were far more likely to report providing patients with after-hours coverage and sharing this responsibility with other practices.  Physicians in Ontario, BC, and Nova Scotia were also consistently more likely to use information technology in their practice, review their performance against targets, and receive financial incentives for certain areas of care.

Ontario and BC are two provinces that have invested heavily in improving their primary care system. Over the last decade, most primary care physicians in Ontario have joined new practice models, signing contractual agreements with government which require or incentivize them to formally enroll patients and mandate after hours care provision. Ontario physicians in some practice models are financially penalized if their patient goes to a walk-in clinic and financially rewarded if their patients meet certain quality of care targets. Adoption of electronic medical records is subsidized in most models and required in some. And, a provincial-wide quality improvement program has helped hundreds of physicians improve access in their clinics.

BC took a different but similarly ambitious approach to reform. Since 2002, the General Practices Services Committee – a partnership between the BC Medical Association and BC Ministry of Health – has championed several initiatives ranging from new financial incentives for chronic illness management, changes to billing codes to encourage telephone and email consultation with patients, and a comprehensive practice support program that includes training on improving access for patients.

Other provinces have also dabbled in primary care reforms but as pointed out by the Health Council of Canada years ago, we have not systematically studied the results of reform efforts across the country or spread successful approaches.

The wide range in quality of care measures between provinces should make us question the notion of a “Canadian” health care system. The federal government has defended its hands off approach to health care but without its influence, Canadians living in different provinces will continue to have very different health care experiences – to the detriment of some of our citizens.

It was fantastic to see the British celebrate their pride in their National Health Service  at the opening ceremonies of the recent Summer Olympics. We need continued investment and thoughtful oversight of health care from our federal government to ensure we can maintain similar pride in Canadian Medicare.

This blog is republished with the permission of the Health Council of Canada.

The comments section is closed.

  • DREarle says:

    From the Washington Post

    Put into an international perspective, however, Canada’s system looks to be relatively well liked. %featured%A 2011 Gallup Poll found that 57 percent of Canadians felt “satisfied” or “very satisfied” with their access to health care services (in the United States, that number stood at just 25 percent)%featured%.

    57% Canadians are satisfied or very satisfied. In the US it is 25%. Not too bad eh.

  • Elaine Rose says:

    A very interesting article. But, why would anyone ever be satisfied? Whether we are discussing healthcare or something else, we should always be looking for ways to improve. As for healthcare, until we truly make it health care rather than illness care, we have a long way to go. Spending more money is not the answer. Coordination of many areas of society need to come together to address the determinants of health. Poverty, low socioeconomic status, low education level, poor support systems, low or inadequate childhood development, and mental health are just some of the areas that need to be addressed. As long as healthcare. education, social services, housing, and other areas of government work in silos and do not communicate healthcare struggles will continue and not be resolved.

    Harder work, with less resources, will not solve problems. Rather than look at what is not working maybe we could look at what is working in a variety of areas within our society and see how we can make those areas even better. Look at the areas and programs that are working and see how we can make them work better. How can we incorporate health and wellness into our education system, into our work environments, and into our small communities? How can our seniors help our pre-school and school age children and vice-versa? What kind of health promotion and healthcare can be implemented in the work environment/? How do our labour laws affect wellness or lack of?

    Ask questions; why? what if?

  • Cynthia Sunstrum says:

    An interesting article. I was surprised by your statement regarding Canadians satisfaction with our health care system(s) as I have rarely (never?) spoken with anyone who didn’t think significant improvement was needed. Sure enough, the report you referenced would lead a reader to believe that everything is hunky dory (provided the cautions regarding interpretation of the results aren’t read). I’m concerned that reporting high satisfaction levels promotes complacency among Canadians who are in fact dissatisfied but don’t demand more because they’re led to believe they are in the minority. The cynical side of me wonders if that is not the objective! Given the current absence of national leadership, it will be increasingly important for grassroots Canadians to rally to demand better. Articles like yours help to demonstrate that we don’t have a universal Canadian health care system and that we can do better. Thanks.

  • Shawn Whatley says:

    Thanks for your blog, Dr. Kiran!

    I appreciate your focus on access. It seems that some think limited access will save money, but limited access forces patients to present with more advanced – more costly – disease when they finally get ‘in’ to the healthcare system. Access, quality and efficiency become inextricably linked.

    We need to stop thinking that making patients wait will save money.

    Thanks again. I hope the public picks up and carries the charge.



  • Marcel Gignac says:

    Our healthcare problems in Canada are a result of an ignorant medical system and a corrupt government. The real losers are not just the patients but also the taxpayers.

    In this country a diagnosis of a terminal or chronic illness automatically moves one from patient to ‘cash cow” for doctors and pharmaceutical companies. They are coerced and even threatened to use expensive medications that in most cases besides not working also makes them worse requiring more expensive medications and hospital visits. This is all subsidized by the taxpayers.

    I was diagnosed with a fatal illness and informed that I had less than a year to live. I luckily found a doctor that actually cares for his patients instead of his bank account and signed my authorization to use and possess medicinal cannabis. I stopped taking the 27 pills per day and instead of dying, I got better. That also saves Canadian taxpayers over $60,000 per year on top of weekly doctor and hospital visits for follow-ups and diagnostic testing which are also paid by taxpayers.

    After being told I would never see 2009, it is now 2013 and I only see my doctor once per year to sign my paperwork. My using only cannabis has saved our healthcare system over $500,000 as well as saved my family the cost of a funeral. And I am not the only one.

    And yet they call us the stupid ones or criminals.

    Marcel Gignac
    Communications Officer


Tara Kiran


Tara Kiran is a family physician at the St. Michael’s Hospital Academic Family Health Team, a Scientist at the MAP Centre for Urban Health Solutions and the Fidani Chair in Improvement and Innovation at the University of Toronto.

Tara Kiran

Auteure contributrice

Tara Kiran est médecin de famille à l’équipe de santé familiale universitaire de l’Hôpital St. Michael, scientifique au MAP Centre for Urban Health Solutions et titulaire de la Chaire Fidani en amélioration et innovation de l’Université de Toronto.

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