Under embargo until February 16, 2017, 10 a.m. ET Chartbook February 2017 How Canada Compares Results From The Commonwealth Fund’s 2016 International Health Policy Survey 2 Production of this document is made possible by financial contributions from Health Canada and  provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca copyright@cihi.ca 3 ISBN 978-1-77109-557-0 Table of contents Executive summary 4 About this chartbook 9 Timely Access to Care 11 Cost Barriers to Care 27 Person-Centred Care 35 Overall perceptions of care Patient experience with regular doctor Hospital patient experience Continuity of care Acknowledgements and methodology notes Appendix 53 59 4 Executive summary Delivering care that is centred around the patient is a health care goal in Canada and many other developed countries. By comparing the experiences of Canadians with those of adults in 10 other developed countries, this chartbook provides important perspective on how well health systems in Canada are meeting the needs and expectations of patients. Canadians continue to report longer wait times for doctors, specialists and emergency department visits than their peers in other countries. However, once they do get medical care, Canadians generally report positive experiences with their regular providers, as well as coordination of care between providers that is similar to or better than the international average. Meriting further exploration are results suggesting that Canadians are more frequent users of some health services (e.g., emergency departments, drugs, doctor consultations) than people in most other countries, and that low-income Canadians are facing greater cost barriers to care overall. Finally, the chartbook highlights variations in results — both within Canada and between countries. This provides an opportunity to learn from policies and best practices in higher-performing jurisdictions. 5 Executive summary (cont’d) The matrix below provides a summary of Canadian results by theme compared with the international average of countries. The number in each cell represents the number of measures in each theme that are above, the same as or below The Commonwealth Fund (CMWF) average of 11 countries. Above average Same as average Below average Timely Access to Care 1 0 7 Cost Barriers to Care 2 0 3 Person-Centred Care 11 10 7 6 Executive summary (cont’d) Timely Access to Care Canada continues to perform below the international average for timely access to patient care. Most Canadians (93%) have a regular doctor or place of care, but they generally report longer wait times for medical care than adults in comparable countries. One possible reason for longer waits here is that Canadians consult with physicians more often than people in other countries. • Only 43% of Canadians report that they were able to get a same- or next-day appointment at their regular place of care the last time they needed medical attention — the lowest percentage of all countries. • Only 34% of Canadians report that they could get care on evenings or weekends without going to an emergency department. However, after-hours access is closer to the international average (43%) in some provinces (Ontario and Alberta). • Canadian patients are generally not seeing improvements in timely access to primary care over time. This is contrary to what primary care physicians reported in The Commonwealth Fund’s 2015 survey. • Canadians visit emergency departments more often than people in other countries and wait longer for emergency care; Canada has the highest proportion of patients waiting 4 or more hours during a visit. • Reported wait times for specialists and non-emergency surgeries in Canada are also the highest among the 11 countries, with all provinces showing significantly longer waits for specialists. 7 Executive summary (cont’d) Cost Barriers to Care Canadians report few financial barriers for medical services covered under the Canada Health Act, but they are more likely than those in other countries to skip filling a prescription or visiting a dentist because of the cost. • Compared with the international average, fewer Canadians report skipping a medical appointment, test or treatment due to cost. • 1 in 10 Canadians — a higher proportion than the international average — report that they didn’t fill a prescription or skipped a dose due to cost. Despite cost barriers, prescription drug use is higher in Canada than in most other surveyed countries, with 58% of Canadians reporting they use 1 or more prescription drugs (the international average is 52%). • More than 1 in 4 (28%) Canadians report skipping a dental visit because of the cost, compared with 1 in 5 internationally. • Canadians with below-average income face cost barriers for all health services more often than those with average or above-average income. Other research suggests the cost of transportation to medical appointments or taking time off work can be a barrier to care for low-income Canadians.* • Canadians younger than 65 are more likely to be worried about being able to pay for housing and nutritious meals than their peers in most other countries, and younger Canadians face more cost barriers to drugs and dental care. 8 Executive summary (cont’d) Person-Centred Care Once they do get in for a visit, Canadians are generally happy with the medical care they receive from their regular doctor or place of care. However, their overall views about their health care system are less positive. • Nearly 3 in 4 Canadians rate the quality of care they receive from their regular doctor as very good or excellent; however, 55% also believe the health care system overall requires fundamental changes. • Canadians report better experiences than the international average when it comes to their regular doctor knowing their medical history, involving them in medical decisions and explaining things in a way that is easy to understand. • When it comes to health promotion and disease prevention, Canadians have more discussions with their primary care providers about healthy lifestyle choices than patients in most other countries, with Alberta, Manitoba and Ontario leading the way. • With regard to hospital stays, patients report results that are similar to the international average overall. Most Canadians also report good hospital discharge planning, with staff arranging follow-up care and providing written instructions for symptoms to watch for at home. • Results suggest that coordination of patient care between regular providers and specialists could be improved in all countries. Similar to the international average, 1 in 5 Canadians report that their regular doctor did not seem up to date about the care they received from a specialist. 9 About this chartbook The 2016 edition of The Commonwealth Fund International Health Policy Survey focused on the views and experiences of the general population (age 18 and older) in 11 developed countries. This chartbook highlights the Canadian story and examines how these experiences vary across Canada relative to comparator countries and how they are changing over time. To provide additional context, this chartbook also references information from the Canadian Institute for Health Information (CIHI) and other sources. References (*) can be found in the notes panels of applicable slides. Supplementary data tables are available online. These show more detailed responses to the questions presented here as well as some additional questions not covered in this chartbook. Full data sets of the survey results are available to researchers upon request by writing to cmwf@cihi.ca. As well, an accessible PDF version of this chartbook is available on CIHI’s website. 10 About this chartbook (cont’d) Interpreting results CIHI applied statistical methods to determine whether Canadian and provincial results were significantly different from the international average of 11 countries. Results are displayed throughout the chartbook using the following colour codes: Above average Same as average Below average Above-average results are more desirable relative to the international average, while below-average results often indicate areas in need of improvement. Sample sizes in some provinces are much smaller than in others and have wider margins of error. For this reason, 2 provinces may have the same numeric results with different significance testing relative to the international average. The most robust samples are in Quebec and Ontario because of the additional funding provided from these provinces. The overall response rate for the survey in Canada was 21.4%. 11   Timely Access to Care   Most Canadians (93%) have a regular doctor or place of care, but they have trouble accessing their health care system in a timely manner. 12 Same- or next-day appointments are difficult to get in Canada Last time you were sick or needed medical attention, how quickly could you get a same- or next-day appointment to see a doctor or a nurse? How does Canada compare (2016)? Comparison by year Netherlands 77% 70%62% New Zealand 76% 60% Australia 67% 57% United Kingdom 57% Switzerland 57% 40% 42% 30% France 56% 20% 53% United States 51% Sweden 43% Canada 43% Above average Same as average 38% 43% 10% 0% 49% Norway 57% 50% CMWF average Germany 55% 2010 2013 Canada Below average 13 CMWF average 2016 Access to after-hours care continues to be below average in Canada Is it very/somewhat easy to get medical care in the evenings, on weekends or on holidays without going to the hospital emergency department? How does Canada compare (2016)? Netherlands 72% New Zealand 53% Australia 49% Norway 49% CMWF average 43% United Kingdom 43% United States 42% Switzerland 41% Germany 36% France Canada Sweden Above average Comparison by year 35% 45% 2010 2013 24% Below average 14 43% 36% Canada 34% Same as average 50%46% 45% 40% 35% 30%34% 25% 20% 15% 10% 5% 0% 34% 2016 CMWF average Canadian doctors report improvements to timely care, but patients don’t agree Same- or next-day appointments 60% 0.53 50% 0.39 40% After-hours care 60% 0.45 50%0.43 43% 42% 40% 38% 30% 30% 20% 20% 10% 10% 0 0 0 2010 0% 2012 Patients 2013 0% 2015 34% 36% 34% 0 0 0 0% 0% 0% 2009 0.48 0.45 0% 2009 2016 2010 Patients Physicians 0% 2012 2013 0% 2015 2016 Physicians Patients who say they could get a same- or next-day appointment Patients who say it was easy or somewhat easy to access medical care after hours without going to the emergency department Primary care physicians who say most (at least 60%) of their patients can get a same- or next-day appointment Primary care physicians who report having after-hours care arrangements 15 Communication with doctors not as easy in Canada 59 % of Canadians often or always receive an answer the same day when they contact their regular doctor’s office with a medical Comparison by year concern. How does Canada compare (2016)? France 86% Germany 79% Australia 76% Switzerland 76% Netherlands 75% New Zealand 74% CMWF average 80% 68% 70% 72% United States 68% 60% 60% 50% United Kingdom 68% 40% Norway 65% Sweden 61% Canada 59% Above average Same as average 72% 59% 30% 20% 10% 0% 2013 2016 Canada Below average 16 CMWF average Timely access to primary care varies across the country While results are below the international average in most parts of the country, some provinces report timelier access to regular care. N.L P.E. . I. N. S. N.B Qu Ont Man Sas . e. . . k. CMW Alt B.C Can F a. . . avg. Able to get same- or next-day appointment to see a doctor or a nurse 34% 30% 34% 33% 39% 44% 47% 49% 48% 44% 43% 57% Very/somewhat easy to get medical care in the evenings, on weekends or on holidays without going to the hospital emergency department 16% 25% 26% 35% 27% 40% 34% 32% 42% 27% 34% 43% Always/often receive an answer the same day 61% when they contact their regular doctor’s office with Above average Same as average a medical concern 70% 64% 50% 54% 62% 57% 51% 58% 64% 59% 72% Below average 17 Canadians report more timely access to mental health care than those in other countries More Canadians — 59% — who experienced emotional distress were able to get professional help when they needed it. Canada 1 in 4 surveyed Canadians say they experienced emotional distress, such as anxiety or great sadness, in the past 2 years, which they found difficult to cope with by themselves. Above average Same as average 59% Below average 18 CMWF average 54% Canadians are high users of emergency departments Adults who used an emergency department in the past 2 years How does Canada compare (2016)? Germany Netherlands 20% 22% New Zealand 23% United Kingdom 24% CMWF average Switzerland 26% 30% 33% United States 35% Sweden 41% Same as average 29% 2010 37% Canada 41% 40% 27% 20% 15% 10% 5% 0% 27% France Above average 50% 44% 45% 40% 35% 30% 25%30% 11% Australia Norway Comparison by year 2013 Canada Below average 19 2016 CMWF average Many Canadians use EDs because they can’t get appointment with The last doctor time you went to the hospital emergency department, was it for a regular condition that you thought could have been treated by the doctors or staff at the place where you usually get medical care if they had been available? How does Canada compare (2016)? France How do the experiences of urban and rural Canadians compare? 20% Australia 28% United Kingdom 29% 56% 37% Switzerland 30% New Zealand 31% Sweden 32% Netherlands 33% CMWF average 34% Norway 40% Canada 41% Germany 42% United States Above average Urban Canadians Did you know? In rural 47% Same as average Rural Canadians Below average 20 Canada, the ED may be the only place to receive treatments that are performed in family practice settings Potentially avoidable use of ED improving slightly in Canada The last time you went to the hospital emergency department, was it for a condition that you thought could have been treated by the doctors or staff at the place where you usually get medical care if they had been available? Comparison by year 50%45% 45% 40% 35% 30%35% 25% 20% 15% 10% 5% 0% 46% 33% 34% 2010 2013 2016 41% Canada 21 CMWF average Sources of potentially avoidable ED visits identified in 2014 CIHI study Emergency department visits, 2013–2014* Nearly half of these patients came to the ED for the following reasons: • Acute upper respiratory infection (13%) In 2013–2014, more than 1.4 million visits to Canadian EDs were potentially avoidable or for conditions that could have been treated at a doctor’s office or clinic 22 • Antibiotic therapies (13%) • Throat inflammation (8%) • Ear infection (7%) • Post-surgical care, such as dressing change (5%) Emergency department wait times are longest in Canada 29 % of Canadians report waiting 4 or more hours the last time they went to the hospital emergency department. 4 or more hours France 1% Germany 3% Netherlands 4% Switzerland 7% United Kingdom 8% Never treated/left without being treated New Zealand 10% Australia 10% CMWF average 11% United States Norway Sweden Canada wait time breakdown Less than 1 hour 1.01% 11% 29.29% 13% 20% Canada Above average 34.34% 29% Same as average Below average 23 35.35% Never 1 hour totreated/left less than 4 hours without being treated Less than than 1 4 or more hours hour 1 hour to less than 4 hours 4 or more hours Emergency department use varies across the country Canadian adults who P.E.I N.S N.B Sask B.C Can CMWF N.L. . . . Que. Ont. Man. . Alta. . . avg. Used an emergency department in the past 2 years 44% 44% 46% 58% 38% 40% 41% 35% 46% 42% 41% 27% Waited 4 or more hours the last time they went to the hospital emergency department 39% 28% 26% 28% 51% 24% 30% 15% 22% 17% 29% 11% Last visited an emergency department for a condition that could have been treated by providers at usual place of care if they had been Note available 49% 60% 48% 52% 41% 44% 40% 43% 30% 36% 41% 34% Above-average results are more desirable relative to the international average, while below-average results often indicate areas in need of improvement. Above average Same as average Below average 24 Wait times for specialists are longest in Canada and not Patients who waited 4 weeks or longer to see a specialist, after improving they were advised or decided to see one in the last 2 years How does Canada compare (2016)? Switzerland Comparison by year 22% Netherlands 23% 60%56% United States 24% 50% Germany 25% 35% France 36% 30%35% CMWF average 36% 20% 37% Sweden 2010 52% Canada Above average 0% 44% Norway 56% Same as average 36% 32% 10% 42% New Zealand 56% 40% Australia United Kingdom 57% 2013 Canada Below average 25 2016 CMWF average Wait times for specialists significantly longer than international average in Patients who waited 4 weeks or longer to see a specialist, after all provinces they were advised to or decided to see one in the last 2 years N.L . 67% P.E.I N.S . . 55% 48% N.B Que Ont . . . Ma n. Sask . Alt a. B.C . Can . CMW F avg. 62% 62% 48% 49% 51% 56% 36% 59% 57% Note Above-average results are more desirable relative to the international average, while below-average results often indicate areas in need of improvement. Above average Same as average Below average 26 Wait times are longer than average in Canada for all elective surgeries Median wait times for priority procedures in 2014 (days) Patients who waited 4 months or longer for elective surgery in last 2 years (2016) 126 Germany 0% France United States Netherlands Desirable Switzerland 73 2% 100 98 48 3% 4% 6% Australia 8% CMWF average 9% Sweden 12% United Kingdom 12% Norway 15% New Zealand 15% Canada Above average 87 Note The Commonwealth Fund average median wait time is calculated using the following countries: Australia, Canada, New Zealand, Norway and the United Kingdom. (Sources: OECD and CIHI*) 18% Same as average Below average 27 While Canada performs better when it comes to wait times for priority procedures (cataract, hip and knee), these procedures account for less than half of elective surgeries in Canada.*   Cost Barriers to Care   Canadians report few financial barriers to medical care in general, but they do report greater-than-average cost barriers when filling prescriptions and seeing a dentist. They also report greater financial worries overall. 28 Canadians worry about money for rent or the mortgage, particularly younger age groups People who are usually or always worried Younger Canadians (25 to 34) worry more or stressed about having enough money to pay rent or the mortgage (over the past 12 months) often about money for rent or the mortgage than those in other age groups 20% How does Canada compare (2016)? 17% 15% Desirable 15% 10% Germany France Norway United Kingdom New Zealand Sweden CMWF average Australia Netherlands Canada Switzerland United States Above average 10% 9% 10% 10% 11% 9% 7% 3% 4% 6% 6% 7% 7% 8% 9% 9% Same as average 5% 0% 18–24 11% 12% 12% 25–34 Canada 16% Below average 29 35–49 50–64 65+ CMWF average Food insecurity is a challenge for younger Canadians People who always or often worry about having enough money to buy nutritious meals Percentage of food-insecure households in Canada, provinces and territories, 2011– 2012 (Statistics Canada*) 20% 17% 15% 14% 12% 10% 8% 7% 9% 8% 8% 9% 6% 5% 0% 18–24 25–34 Canada 35–49 50–64 65+ CMWF average 30 Few Canadians face cost barriers to care covered under Canada Health Act Within last year, had a medical problem but did not visit a doctor because of the cost Within last year, skipped a medical test, treatment or follow-up because of the cost Germany Sweden Netherlands United Kingdom Norway Canada CMWF average France Australia New Zealand Switzerland United States Above average How does Canada compare (2016)? Desirable Desirable How does Canada compare (2016)? 3% 3% 3% 4% 5% 6% 9% 9% 9% Same as average 14% 16% 22% Below average 31 United Kingdom Sweden Netherlands Norway Germany Canada Australia CMWF average New Zealand Switzerland France United States 3% 3% 4% 4% 5% 6% 7% 7% 10% 10% 12% 19% More Canadians face cost barriers to dental care and prescription drugs Within last year, did not fill prescription for medicine or skipped doses of medicine because of the cost Within last year, skipped dental care or dental checkups because of the cost United Kingdom Germany Norway France Netherlands Sweden New Zealand Australia CMWF average Switzerland Canada United States Above average How does Canada compare (2016)? Desirable Desirable How does Canada compare (2016)? 2% 3% 3% 4% 4% 6% 6% 6% 6% 9% 10% Same as average 18% Below average 32 Netherlands United Kingdom Germany Sweden CMWF average Norway Switzerland Australia New Zealand France Canada United States 11% 11% 14% 19% 20% 20% 21% 21% 22% 23% 28% 32% Despite cost barriers, use of prescription drugs is higher in Canada than in most other countriesof Canadian adults report taking 1 or more prescription drugs 58 % on a regular basis. Australia 46% United Kingdom 47% Switzerland 48% France 48% New Zealand 49% Polypharmacy higher in Canada than in other CMWF countries CMWF average 52% Sweden 52% Netherlands 52% Germany 53% United States 57% Canada 58% Norway 59% Above average Same as average 1 in 5 Canadians report that they take 4 or more prescription drugs on a regular basis (CMWF average is 1 in 6). Below average 33 Younger adults report greater financial barriers to drugs and dental care Within last year, skipped dental care or dental checkups because of the cost 40% 30% 20% Within last year, did not fill prescription for medicine or skipped doses of medicine because of the cost 38% Canada 30% 27% 26% CMWF average 27% 23% 19% Adults 18–64 21% 20% 12% 7% 4% 4% Seniors (65+) 12% 10% 0% 18–24 25–34 Canada Above average 35–49 50–64 65+ All Canadian provinces and territories provide drug coverage for seniors 65+. CMWF average Same as average Below average 34 Cost barriers to all care are highest for low-income Canadians 45% 41% 40% 35% 30% 25% 20% 17% 15% 10% 5% 17% 11% 9% 3% 4% 3% 0% Below-average income 35 Above-average income   Person-Centred Care   Canadians are generally happy with the medical care they receive from their regular doctor or place of care, but they are less positive about their health care system overall. Coordination of care has been improving both in Canada and internationally, though there are still challenges. 36 Most Canadians have a regular doctor or place where they receive care Is there one doctor you usually go to for your medical care? How does Canada compare (2016)? 85% France 99% Netherlands 99% Germany 98% Norway 95% New Zealand 89% Australia 86% CMWF average 85% Switzerland 85% Canada 81% United States Sweden Above average 77% 42% Same as average Canadians have a usual doctor 93% of Canadians have a usual doctor or place they go to for medical care 85% United Kingdom of Below average 37 Canadians like their usual physician but don’t think the system works well Overall, how do you rate the medical care that you have received in the past 12 months from your regular doctor’s practice or clinic (2016)? (Excellent/very good) New Zealand Canada United States Australia United Kingdom CMWF average Switzerland Norway Netherlands France Germany Sweden Above average How would you rate the overall quality of medical care in your country? (Excellent/very good) 79% 74% 73% 72% 70% 65% 64% 63% 62% 60% 54% Switzerland United Kingdom Australia New Zealand France Netherlands CMWF average Norway Germany Canada Sweden United States 39% Same as average Below average 38 66% 63% 59% 58% 52% 51% 51% 50% 49% 45% 39% 26% Most Canadians think the health care system needs fundamental changes to work better Which of the following statements expresses Overall view of the health care your overall views of the system (Canada, 2016)? system: It works well and only minor changes are necessary to make it better On the whole, the system worksthe pretty well andthe only On whole, minor changes are necessary system works pretty to make it work better. 8.91% 1.98% 34.65% 54.46% Above average Same as average well and only minor There are some changes aregood things in our health care system, necessary makeareit but fundamentalto changes neededbetter. to make it work better. work Our health caresome system has There are so much wrong with it that we good things in our need to completely rebuild it. health care system, but fundamental Not sure changes are needed to make it work better. Below average 39 How does Canada compare (2016)? Germany Norway Switzerland France United Kingdom Australia CMWF average Netherlands New Zealand Canada Sweden United States 60% 59% 58% 54% 44% 44% 44% 43% 41% 35% 31% 19% Provinces vary when it comes to perceptions of the health care system P.E.I Man N.L. . N.S. N.B. Que. Ont. . Sas CMW k. Alta. B.C. Can. F avg. Is there one doctor you usually go to for your medical care? 85% 92% 85% 88% 75% 92% 83% 79% 84% 83% 85% 85% Overall, how do you rate the medical care that you have received in the past 12 months from your regular doctor’s practice or clinic? (Excellent/very good) 76% 77% 78% 76% 66% 76% 75% 75% 78% 77% 74% 65% How would you rate the overall quality of medical care in your country? (Excellent/very good) 48% 44% 52% 40% 26% 52% 46% 43% 54% 52% 45% 51% Overall, you think the health care system works pretty well and only minor 35% changes are necessary to make it work Abovebetter. average Same as average 35% 38% 29% 22% 38% 39% 41% 38% 43% 35% 44% Below average 40 Canada relies more on doctors to provide care compared with other CMWF countries Aside from your regular doctor, is there a nurse or other clinical staff who is regularly involved with your health care (for example, who discusses test results/treatment plans or advises you on your health)? How does Canada compare (2016)? Germany 44% United Kingdom 42% New Zealand 41% United States 35% Sweden 32% CMWF average 31% Netherlands 30% France 29% Australia 22% Canada 22% Switzerland Above average Number of physicians per 1,000 people* Canada: 2.5 CMWF average: 3.5 27% Norway Note The Commonwealth Fund average is calculated using the following countries: Australia, Canada, Finland, France, Germany, New Zealand, Norway, Sweden, the United Kingdom and the United States. (Sources: OECD and CIHI*) 17% Same as average Doctor consultations per capita* Canada: 7.6 CMWF average: 5.8 Below average 41 Canadians report better experiences with their regular doctors than 11-country average When you need care or treatment, how often does your regular doctor or the medical staff you see always Know important information about your medical history Canada CMWF average 63% 57% 57% 55% 63% 56% 70% 63% Spend enough time with you Involve you as much as you want in decisions about your care and treatment Explain things in a way that is easy to understand Above average Same as average Below average 42 Canadians are more likely to discuss healthy lifestyle choices as part of care During the past 2 years, have you and your doctor or other clinical staff at the place you usually go to for care talked about N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. Can. CMW F avg. A healthy diet and healthy eating 48% 53% 53% 55% 38% 56% 59% 47% 61% 44% 50% 40% Exercise or physical activity 37% 49% 55% 54% 43% 60% 65% 45% 62% 58% 55% 42% The health risks of smoking and ways to quit 57% 62% 65% 68% 61% 79% 71% 58% 79% 57% 71% 50% Alcohol use 10% 21% 14% 15% 18% 26% 28% 14% 32% 22% 23% 19% Things in your life that worry you or cause stress 28% 35% 30% 29% 28% 38% 38% 31% 40% 36% 35% 28% Above average Same as average Below average 43 Canadians more likely to receive medication reviews 77 % of Canadians with 2 or more prescription drugs had a doctor, nurse or pharmacist review their medications in the last 2 years. How does Canada compare (2016)? United States 82% United Kingdom 79% Canada 77% Australia 75% Netherlands 72% New Zealand 71% CMWF average 68% Germany 66% Switzerland France Above average Medication reviews are important for patient safety. In 2010–2011, nearly 47,000 Canadians were hospitalized due to an adverse drug reaction.* 63% Sweden Norway Did you know? 58% 55% 45% Same as average Below average 44 Fewer Canadians have online access to health information Viewed online or downloaded your health information, such as your tests or laboratory results, in last 2 years Emailed your regular practice with a medical question in last 2 years How does Canada compare (2016)? France United States Norway CMWF average Netherlands Sweden Switzerland New Zealand United Kingdom Canada Australia Germany Above average How does Canada compare (2016)? 27% 25% France United States CMWF average Australia Sweden Norway Switzerland Germany New Zealand Netherlands United Kingdom Canada 12% 11% 10% 10% 8% 7% 7% 6% 5% 4% Same as average Below average 45 24% 12% 8% 8% 8% 7% 7% 6% 6% 5% 5% 4% Online access to personal health information low across most provinces Viewed online or downloaded your health information, such as your tests or laboratory results N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask. Alta. B.C. Can. Viewed online or downloaded health information, such as tests or laboratory results 1% 1% 6% 2% 6% 6% 2% 1% 4% 14% Did you know? B.C. currently has 730,000 users who are registered on my ehealth and have the ability to access reports from both private and public outpatient labs.* Above average Same as average Below average 46 6% CMWF avg. 11% Patient-centred care in Canadian hospitals is similar to the international average Thinking about the last time you were in the hospital, Were you involved as much as you wanted in decisions about your care and treatment? (Yes, definitely) During this hospital stay, how often did doctors treat you with courtesy and respect? (Always) Canada CMWF average 58% 61% 73% 73% 65% 71% During this hospital stay, how often did nurses treat you with courtesy and respect? (Always) Above average Same as average Below average 47 Hospital inpatient experience varies across Canada Thinking about the last time you were in the hospital, N.L. P.E.I. N.S. N.B. Que. Ont. Man. Sask.* Alta. B.C. Can. CMWF avg. Were you involved as much as you wanted in decisions 68% about your care and treatment? (Yes, definitely) 61% 41% 61% 66% 51% 50% 65% 63% 56% 58% 61% During this hospital stay, how often did doctors treat you with courtesy and respect? (Always) 77% 67% 56% 74% 85% 68% 72% 83% 64% 79% 73% 73% During this hospital stay, how often did nurses treat you with courtesy and respect? (Always) 59% 51% 52% 62% 84% 60% 58% 71% 48% 67% 65% 71% Note * Sample size was less than 30. Please interpret with caution. Above average Same as average Below average 48 Most hospital patients report comprehensive discharge planning When you left the hospital, Did someone discuss with you the purpose of taking each of your medications? Did the hospital make arrangements for or make sure you had follow-up care with a doctor or other health care professional? Did you receive written information on what to do when you returned home and what symptoms to watch for? Above average Same as average Below average 49 Canada CMWF average 83% 82% 73% 73% 75% 74% Two-way communication between specialists and regular doctors can be improved in most countries The specialist did not have basic medical information or test results from your regular doctor about the reason for your visit (2016) New Zealand Australia Germany United Kingdom Canada Norway CMWF average Netherlands United States Sweden Switzerland France Above average After you saw the specialist, your regular doctor did not seem informed and up to date about the care you got from the specialist (2016) 8% United Kingdom New Zealand Germany Australia Switzerland Netherlands CMWF average Canada France Sweden United States Norway 11% 13% 13% 13% 14% 15% 16% 17% 18% 19% 22% Same as average Below average 50 11% 14% 15% 16% 17% 18% 19% 21% 21% 23% 23% 29% Communication between specialists and regular doctors varies across the country N.B . N.L. P.E.I. N.S. CMWF Que. Ont. Man. Sask. Alta. B.C. Can. avg. The specialist did not have basic medical information from your regular doctor about the reason for your visit 10% 17% 11% 8% 13% 14% 23% 9% 11% 16% 13% 15% After you saw the specialist, your regular doctor did not seem informed and up to date about the care you got from the specialist 22% 15% 12% 16% 21% 23% 30% 19% 21% 14% 21% 19% Above average Same as average Below average 51 Conflicting information biggest challenge for coordination of care Above average 8% 8% 9% 12% 13% 14% 15% 16% 17% 17% 20% 20% Same as average Australia Netherlands Switzerland Germany United Kingdom New Zealand Norway CMWF average Canada Sweden United States France Doctors ordered a medical test that you felt was unnecessary because the test had already been done 5% 5% 6% 6% 6% 7% 7% 8% 8% 8% Desirable Netherlands Germany France United Kingdom Australia CMWF average New Zealand Switzerland Canada United States Sweden Norway Test results or medical records were not available at the time of your scheduled medical care appointment Desirable Desirable You received conflicting information from different doctors or health care professionals 11% 13% Below average 52 Netherlands New Zealand Sweden United Kingdom Canada Norway Germany Australia CMWF average Switzerland United States France 3% 4% 5% 5% 6% 6% 6% 6% 7% 9% 11% 20% International progress in reducing coordination problems You received conflicting information from different doctors or health care professionals Test results or medical records were not available at the time of your scheduled medical care appointment Doctors ordered a medical test that you felt was unnecessary because the test had already been done 25% 12%11% 20% 20% 10% 12% 10% 10% 18% 15% 17% 8%9% 15% 6% 6% 4% 4% 2% 2% 9% 8% 8% 14% 5% 0% Canada 2016 7% 8% 7% 6% 0% 2013 10% 8% 15% 10% 2010 11% 2010 0% 2013 Canada 53 2016 2010 2013 Canada 2016 Acknowledgements Core funding for The Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 countries was provided by The Commonwealth Fund with co-funding from the following organizations outside of Canada: The NSW Bureau of Health Information (Australia); the Victoria Department of Health and Human Services (Australia); the Haute autorité de Santé (France); the Caisse nationale de l’assurance maladie des travailleurs salariés (France); the Institute for Quality Assurance and Transparency in Healthcare (IQTIG) (Germany); the Scientific Institute for Quality of Healthcare, Radboud University Nijmegen (the Netherlands); the Dutch Ministry of Health, Welfare and Sport (the Netherlands); the Norwegian Knowledge Centre at the Norwegian Institute of Public Health; the Swedish Ministry of Health and Social Affairs; the Swedish Agency for Health and Care Services Analysis (Vårdanalys); the Swiss Federal Office of Public Health; and other country partners. Within Canada, funding for an expanded Canadian sample was provided by the Canadian Institute for Health Information (CIHI), the Canadian Institutes of Health Research’s Institute of Health Services and Policy Research (CIHR-IHSPR), the Commissaire à la santé et au bien-être du Québec and Health Quality Ontario. 55 Acknowledgements (cont’d) CIHI would like to acknowledge and thank the many individuals who assisted with the development of this chartbook, including our expert advisory group: • Dr. Mike Benigeri, Consultant, Health and Welfare Commissioner of Quebec • Dr. Alan Katz, Director, Manitoba Centre for Health Policy, University of Manitoba • Dr. Gail Dobell, Director, Performance Measurement, Health Quality Ontario • Michelina Mancuso, Executive Director, Performance Measurement, New Brunswick Health Council • Annette McKinnon, patient representative • Dr. Jean-Frédéric Levesque, Chief Executive, Bureau of Health Information, New South Wales, Australia Special thanks also go to Lisa Corscadden, Senior Researcher, and Kim Sutherland, Senior Director, Bureau of Health Information, New South Wales, Australia, for their feedback. Please note that the analyses and conclusions in the present document do not necessarily reflect those of the individuals or organizations mentioned above. Appreciation goes to the CIHI staff from the core team as well as the supporting program areas who contributed to the development of this project. Core team members who contributed to this chartbook include Gilles Fortin, Tracy Johnson, Christopher Kuchciak, Christina Lawand, Kathleen Morris, Geoff Paltser, David Paton, Sheril Perry, Alain Yao, Alison Ytsma, Jingbo Zhang and Annie Zhao. 56 Methodology notes The Commonwealth Fund’s 2016 International Health Policy Survey includes responses from adults in 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. Province/ Cell territory Landline phone Total Percentage distribution N.L. 177 76 253 6% P.E.I. 172 79 251 6% N.S. 184 69 253 6% More detailed methodology notes, including a complete list of response rates from all countries surveyed, are available online. N.B. 192 59 251 6% Que. 741 261 1,002 22% Ont. 1,119 381 1,500 33% In Canada, phone surveys (landline and cell phone) were conducted from March through June 2016 by Social Science Research Solutions (SSRS). There were 4,547 respondents. Due to small sample sizes in the 3 territories, these jurisdictions are not included in the provincial results. Sample sizes were further increased in Quebec and Ontario with funding from provincial organizations. The overall response rate in Canada was 21.4%. Man. 201 54 255 6% Sask. 170 81 251 6% Alta. 177 94 271 6% B.C. 183 71 254 6% Y.T. 0 1 1 0% N.W.T. 0 1 1 0% Nun. 1 3 4 0% Total 3,317 1,230 4,547 100% 57 Methodology notes (cont’d) Weighting of results Survey data for Canada was weighted by age, gender, educational attainment and phone status (landline phone with multiple adults versus single adult in household; cell phone only versus dual usage of landline and cell phone) within each province. Data was weighted for knowledge of official languages in Quebec and in Canada as a whole. Additionally, data was then weighted to reflect Canada’s overall geographic distribution for all provinces and territories. Averages and trends For this chartbook, The Commonwealth Fund average was calculated by adding the results from the 11 countries and dividing by the number of countries. The Canadian average represents the average experience of Canadians (as opposed to the mean of provincial results). Except where otherwise noted, results were compared over time using data from previous CMWF surveys. Significance testing CIHI developed statistical methods to determine whether • Canadian results were significantly different from the average of 11 countries; and • Provincial results were significantly different from the international average. For the calculation of variances and confidence intervals, standard methods for the variances of sums and differences of estimates from independent simple random samples were used, with the design effects provided by SSRS used to appropriately adjust the variances for the effects of the survey design and post-survey weight adjustments. 58 Methodology notes (cont’d) Sample size by province Provincial results are flagged for questions for which the denominator is less than 30. Due to small sample sizes, provincial results are to be interpreted with caution. For more information on sample sizes for individual questions, please refer to the companion data tables on CIHI’s website. Sample population This year’s sample population showed some characteristics that were not in line with previous Canadian population surveys. Of particular note were responses about self-perceived health. In past Commonwealth Fund surveys (and other international surveys), Canada has performed above the international average for this measure, while 2016 saw a large drop (11%) in those reporting excellent or very good health. While characteristics for different sample populations selected in each year are not expected to be the same, the low response rate in 2016 may indicate that the population characteristics Self-perceived healthsampled in 2016 may have different Response rate than that sampled in 2013 or 2010. (Excellent/very good) 201 0 2013 201 6 Canada 61% 60% 49% CMWF average 52% 54% 51% 2010 2013 201 6 Canada 29% 24% 21% CMWF average 28% 24% 25% 59 Demographics   N.L P.E. . I. N. S. N.B Que . . Ont . Man . Sas k. Alt a. B. C. Can . Total 253 251 253 251 1,002 1,500 255 251 271 254 4,541 Male 40 41 37 39 40 40 38 45 48 45 41 Female 60 59 63 61 60 60 62 55 52 55 59 18–24 4 6 5 5 4 3 5 4 7 4 4 25–34 7 9 6 11 12 9 11 13 11 8 10 35–49 21 16 19 16 23 20 20 22 23 19 21 50–64 35 34 31 38 35 34 25 27 27 29 33 65+ 30 33 37 28 25 32 34 33 30 38 31 2 2 2 2 1 3 4 1 1 2 2 Gender (%) Age (%) Older than 18, exact age not provided 60 Bibliography Canadian Cancer Society and Canadian Cancer Action Network. Five-Year Action Plan to Address the Financial Hardship of Cancer in Canada. 2012. Canadian Institute for Health Information. Nearly 1 in 5 patient visits to emergency could potentially be treated elsewhere [media release]. November 6, 2014. Canadian Institute for Health Information. Sources of Potentially Avoidable Emergency Department Visits. 2014. Organisation for Economic Co-operation and Development. OECD Health Statistics 2016. Accessed November 1, 2016. Statistics Canada. Table 105-0545: Household food insecurity measures, by living arrangement, Canada, provinces and territories, occasional. Accessed November 1, 2016. The Commonwealth Fund. Multinational Comparisons of Health Systems Data, 2013. 2013. The Commonwealth Fund. The Commonwealth Fund 2009 International Health Policy Survey of Primary Care Physicians in Eleven Countries. 2009. The Commonwealth Fund. The Commonwealth Fund 2010 International Health Policy Survey in Eleven Countries. 2010. The Commonwealth Fund. The Commonwealth Fund 2012 International Health Policy Survey of Primary Care Physicians. 2012. The Commonwealth Fund. The Commonwealth Fund 2013 International Health Policy Survey in Eleven Countries. 2013. The Commonwealth Fund. The Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians. 2015. 61 Canadian Institute for Health Information Better data. Better decisions. Healthier Canadians. @cihi_icis cmwf@cihi.ca