Health Care in Canada Survey 2005 Health Care

Health Care in Canada Survey 2005

Health Care in Canada Partners è Association of Canadian Academic Health Care Organizations è Canadian College of Health Service Executives è Canadian Healthcare Association è Canadian Home Care Association è Canadian Medical Association è Canadian Nurses Association è Canadian Pharmacists Association è Canadian Public Health Association è Health Charities Coalition of Canada è Merck Frosst Canada Ltd. è POLLARA è Rogers Media 2

Table of Contents è Methodology 4 è Detailed Findings 5 n Overview of the Health Care System 6 n Health and Well-Being 13 n Quality and Safety in the Health Care System 24 n Pharmaceuticals and Pharmacists 45 n Role of Public Vs. Private Insurance 57 n Transforming the Health Care System/Innovation 89 n Ensuring Accountability 112 n Experience Vs. Perceptions, and Behaviour 114 3

Methodology Survey results are based on telephone interviews with nationally representative samples of the Canadian public, doctors, nurses, pharmacists and health administrators. Fielding of the core questionnaire was conducted between August 17 and September 2, 2005. Groups Sample Size Margin of Error Canadian Public 1, 207 + 2. 8% Doctors 203 + 6. 9% Pharmacists 202 Nurses 201 + 6. 9% Health Administrators + 6. 9% 201 + 6. 9% Questionnaires were developed by POLLARA working in close consultation with the HCIC partners.

Detailed Findings 5

Overview of the Health Care System 6

Most Important Issue Facing Canada: Tracking % Important 24% Health Care 14% Concerns: Politicia 5% Economy & Deficit/Govt. Spendi 3% Education & Unemp 2% Taxes Q: In your opinion, what is the single most important issue facing Canada today? Source: Perspectives Canada 7

‘Very Concerned’: Tracking 64% Health Care 61% Politicians 49% Environment 47% Education 44% Fed. Taxation 41% Prov. Taxation 35% Trade Dispute with U. S. & Nat’l Resources 28% Crime % Very Concerned 24% Cda’s Security 22% Cda U. S. Border Q: Now thinking more generally, would you say you are very concerned, somewhat concerned, not too concerned, or not at all concerned about the following issues? How about: (READ AND ROTATE) Source: Perspectives Canada 8

Overall Confidence in the Health Care System è 50% of Canadians indicate they have falling confidence in the system. è Confidence drops even further for women and for those between the ages of 35 and 55. (A middle aged angst that is consistent through many of the survey results). è The percentage of those saying they have falling confidence differs across the country for a low of 41% in Atlantic to a high of 58% in Manitoba/Saskatchewan. è Only 5% of Canadians say they have rising confidence in the system.

Tracking of Canadians’ Confidence in the Health Care System 1998 1999 2000 2001 2002 2003 Spring 2004 Fall 2004 Spring 2005 Aug/Sept. 2005 Q: Overall, would you say that your confidence in the Canadian health system is rising or falling, or is it about the same as it ever was? Base: GENPOP Source: HCIC 2005 10

Canadians Confidence in the Health Care System: Demographics - Aug/Sept. 2005 Q: Overall, would you say that your confidence in the Canadian health system is rising or falling, or is it about the same as it ever was? Base: GENPOP Source: HCIC 2005

Canadians Confidence in the Health Care System: Demographics - Aug/Sept. 2005 Q: Overall, would you say that your confidence in the Canadian health system is rising or falling, or is it about the same as it ever was? Base: GENPOP Source: HCIC 2005

Health and Well-Being 13

Public Health Measures è Public perceive that behavioral factors such as eating habits and amount of stress have a high influence on the health of Canadians. They perceive that genetic make-up, education level and income have less of an influence. è Canadians indicate strong support for initiatives to improve health and prevent illness and injury, such as physical education and health eating programs in schools; and police checkstop programs. è When asked about taxes as a healthy public policy measure to encourage lower consumption 41% felt that taxes were too low on cigarettes while only 18% felt they were too low on alcohol 85% of Canadians felt taxes were too high on gasoline.

Public Health Measures è Canadians strongly support a national immunization strategy, with 64% indicating ensuring the security of Canadian supply of vaccines for Canadians would be very important along with improved access to timely immunization programs. è While citing control of vaccine prices as important in a national strategy equally important was ensuring that regulatory and pricing systems encourage companies to conduct vaccine research è 67% of Canadians believe government should subsidize products like nicotine patches to help people quit smoking. This is strongest among those 18 -24 with 80% supporting subsidization, and drops to 59% for those over 65 years of age.

Factors Influencing Health of Canadians Mean Score Max=7 A person's eating habits 5. 8 How much stress a person has in their life 5. 7 Access to quality health care services 5. 5 Quality of air we breathe 5. 5 Genetic make-up inherited from parents 5. 2 A person's level of education 4. 5 A person's level of income 4. 4 Q: I’m going to read you a list of things that may or may not be important factors influencing the health of Canadians. Please tell me how you would rate what impact you think each has. Please use a 7 -point scale where 1 means it has No impact at all and 7 means it has a Very strong impact on health (2005 HCIC) Base: GENPOP

Factors Influencing Health of Canadians % saying strong/very strong impact (6 or 7 out of 7) HCIC 2005 CPHI 2003 A person’s eating habits 65% 72% How much stress a person has in their life 59% 68% Quality of air we breathe 55% 64% Genetic make-up inherited from parents 42% 44% A person’s level of education 28% 33% A person’s level of income 25% 33% Q: I’m going to read you a list of things that may or may not be important factors influencing the health of Canadians. Please tell me how you would rate what impact you think each has. Please use a 7 -point scale where 1 means it has No impact at all and 7 means it has a Very strong impact on Health (HCIC 2005 & CPHI Public Views of the Determinants of Health Survey, 2003) Base: GENPOP

Importance of Initiatives to Improve Health and Prevent Illness and Injury Physical Education programs in schools Healthy eating programs in schools Police checkstop programs to check drivers' blood alcohol levels Community access programs (i. e. community centres) Public information on dietary requirements Fines for not wearing bicycle helmets & seatbelts Very Somewhat Important (9, 10) Important (7, 8) Neutral (5, 6) Somewhat Not Important (3, 4) Not At All Don't Know/ Important (1, 2) Refused Q: How important do you think it is that Canadians be encouraged to improve and maintain their own wellness and take measures to protect their health through each of the following programs, on a scale from 1 -10 where 1 means Not at all important and 10 means Extremely important? Base: GENPOP

Public’s View of Healthy Public Policy Taxes Gasoline Alcoholic beverages Cigarettes and other tobacco products Q: Thinking about how taxes might encourage reduced use of certain products, do you think taxes on the following items are too high, too low or just right? Base: GENPOP

Public’s View of Tobacco Taxes Q: Thinking about how taxes might encourage reduced use of certain products, do you think taxes on the following items are too high, too low or just right? - Cigarettes and other tobacco products. Source: HCIC 2005 Base: GENPOP

Public’s View of Alcohol Taxes Q: Thinking about how taxes might encourage reduced use of certain products, do you think taxes on the following items are too high, too low or just right? - Alcoholic Beverages Source: HCIC 2005 Base: GENPOP

Public’s View of Gasoline Taxes Q: Thinking about how taxes might encourage reduced use of certain products, do you think taxes on the following items are too high, too low or just right? - Gasoline Source: HCIC 2005 Base: GENPOP

Government Subsidies For Products and Programs Such as Nicotine Patches Q: Do you believe that the government should subsidise products like nicotine patches to help people quit smoking and other similar products and programs? Base: GENPOP

National Immunization Strategy Ensuring the security of the Canadian supply of vaccines for Canadians Control of vaccine prices Improved access to timely immunization programs Ensuring that regulatory and pricing systems encourage companies to conduct vaccine research Very Somewhat Important (9, 10) Important (7, 8) Neutral (5, 6) Somewhat Not Important (3, 4) Not At All Don't Know/ Important (1, 2) Refused Q: The federal and provincial governments are working together on a national immunization strategy to ensure that Canadians have access to the latest vaccines. On a scale from 1 to 10 where one means it is not at all important and ten means that it is extremely important, how important are each of the following? (READ AND ROTATE) BASE: GENPOP

Quality and Safety in The Health Care System 25

Waiting Times è A majority of all groups except managers believe that waiting times for elective surgery have become longer in the past 2 years: public (66%), nurses (64%), physicians (58%), pharmacists (58%). 43% of managers felt they had gotten longer. è Few people feel waiting times have gotten shorter ranging from 3% of the public to a high of 17% of managers believing wait times have decreased. è Women (71%) are more likely than men (61%) to say waiting times have gotten longer.

Waiting Times è When looking at perceptions of average waiting times for specific procedures: the Canadian public believes that waiting times for breast biopsies are longer than health care providers do - with 59% of the public, 45% of physicians and 32% of managers expecting it would take 3 weeks or more. è 70% of the public expect emergency room waits to take two hours or more compared to 42% of nurses who believe that. è By contrast, the public is more optimistic than health care providers when it comes to waiting time for hip replacements, with 58% saying they would expect to wait six months or more compared to 77% of physicians and 69% of managers.

Safety In Hospitals è 59% of the public, felt it was likely or very likely that someone might be subject to a serious medical error while being treated at a Canadian hospital. This compared to 39% of physicians, 51% of pharmacists, 62% of nurses and 57% of managers. è More women (66%) than men (51%) feel this is likely to occur.

Emergency Preparedness è Few people (6%) feel we would be “very prepared” for a public emergency situation, like the SARS outbreak. è 44% of the public, 47% of physicians, 34% of pharmacists, 33% of nurses, 30% of managers feel we would be unprepared. è Health providers are concerned a situation like the SARS outbreak will occur again: Physicians (81%), Nurses (85%), Pharmacists (60%), Managers (91%). è 40% of managers and 37% of nurses indicate they are ‘very’ concerned.

Perceptions of Waiting Times for Breast Biopsies Public % saying three weeks or more 59% 45% Doctors Managers 32% Q: Consider a patient with the following symptoms. A 50 year old woman with a lump in her breast who requires a biopsy. On average, how long do you think a patient like this would generally wait from the time a doctor first recommends the test until the time it is carried out? (HCIC 2005 & Commonwealth fund IHP 2003)

Perceptions of Waiting Times for Breast Biopsies % saying three weeks or more 59% 57% 60% 56% 68% 55% 60% Q: Consider a patient with the following symptoms. A 50 year old woman with a lump in her breast who requires a biopsy. On average, how long do you think a patient like this would generally wait from the time a doctor first recommends the test until the time it is carried out? (HCIC 2005 & Commonwealth fund IHP 2003) Base: GENPOP

Perceptions of Waiting Times for Hip Replacements Public % saying six months or more 58% 77% Doctors Managers Q: 69% Consider a patient with the following symptoms. A 65 year old man who requires a routine hip replacement. On average, how long do you think a patient like this would generally wait from the time a doctor first recommends treatment until the time the treatment is received? (HCIC 2005 & Commonwealth fund IHP 2003)

Perceptions of Waiting Times for Hip Replacements % saying six months or more 58% 55% 54% 70% 59% 77% Q: Consider a patient with the following symptoms. A 65 year old man who requires a routine hip replacement. On average, how long do you think a patient like this would generally wait from the time a doctor first recommends treatment until the time the treatment is received? (HCIC 2005 & Commonwealth fund IHP 2003) Base: GENPOP

Average Hospital Waiting Times for. . A breast biopsy for a 50 year old woman with a lump in her breast 2003 Commonwealth Fund International Health Policy Survey of Hospital Executives Health Care in Canada Aug/Sept. 2005 % of patients having to wait AUS NZ UK US CAN Gen Pop Physic. Managers Less than 3 weeks 74% 48% 73% 93% 70% 33% 52% 53% 3 weeks or more 15% 44% 20% 2% 21% 59% 45% 32% A routine hip replacement for a 65 -Year-Old Man Less than 6 months 54% 25% 15% 92% 43% 36% 18% 23% 6 months or more 39% 65% 81% 1% 50% 58% 77% 69% Notes: The Commonwealth Fund Survey asked the questions only of hospitals that perform the procedures. The Commonwealth Fund wording was “A 50 year-old woman with an ill-defined mass in her breast but no Adenopathy. ”

Perceptions of Emergency Room Waiting Times % saying two hours or more Public Doctors Nurses Managers 70% 63% 42% 50% Q: On average, how long do you think patients wait to be seen in the hospital emergency room? (HCIC 2005 & Commonwealth fund IHP 2003)

Perceptions of Emergency Room % saying two Waiting Times hours or more 70% 66% 78% 73% 60% 64% Q: On average, how long do you think patients wait to be seen in the hospital emergency room? (HCIC 2005 & Commonwealth fund IHP 2003) Base: GENPOP

Perceptions of Emergency Room Waiting Times 2003 Commonwealth Fund International Health Policy Survey of Hospital Executives Percent reporting an average wait of two or more hours Health Care in Canada Aug/Sept. 2005 AUS NZ UK US CAN Gen Pop Phy sic. Nurs es Mana gers 23% 17% 58% 39% 46% 70% 63% 42% 50% Q: On average, how long do you think patients wait to be seen in the hospital emergency room? (HCIC 2005 & Commonwealth fund IHP 2003)

Perceptions of Waiting Times for Elective Surgery in the Past 2 Years Public Doctors Pharmacists Nurses Managers Q: In the past 2 years, do you think that waiting times for elective surgery have become longer or shorter or have they remained the same? (HCIC 2005 & Commonwealth fund IHP 2003)

Perceptions of Waiting Times for Elective Surgery in the Past 2 Years Q: In the past 2 years, do you think that waiting times for elective surgery have become longer or shorter or have they remained the same? (HCIC 2005 & Commonwealth fund IHP 2003) Source: HCIC 2005 Base: GENPOP

Perceptions of Waiting Times for Elective Surgery in the Past 2 Years 2003 Commonwealth Fund International Health Policy Survey of Hospital Executives Health Care in Canada - Aug/Sept. 2005 AUS NZ UK US CAN Gen Pop Physic. Pharmacists Nurses Managers Gotten Longer 11% 18% 8% 27% 44% 66% 58% 64% 43% Gotten Shorter 21% 29% 86% 14% 9% 3% 6% 6% 3% 17% Q: In the past 2 years, do you think that waiting times for elective surgery have become longer or shorter or have they remained the same? (HCIC 2005 & Commonwealth fund IHP 2003)

Likelihood of Serious Medical Errors Total Likely Public Doctors 59% 39% Pharmacists 51% Nurses 62% Managers 57% Q: How likely do you feel it is that someone might be subject to a serious medical error while being treated at a Canadian hospital? Would you say that it is not at all likely, somewhat unlikely, somewhat likely or extremely likely?

Likelihood of Serious Medical Errors Total Likely 59% 68% 54% 62% 63% 52% 54% 51% 66% 51% 53% 54% 60% 67% 61% Q: How likely do you feel it is that someone might be subject to a serious medical error while being treated at a Canadian hospital? Would you say that it is not at all likely, somewhat unlikely, somewhat likely or extremely likely? Base: GENPOP

Preparedness for Public Emergency Situations Total Unprepared Public 44% Doctors 47% Pharmacists 34% Nurses 33% Managers 30% Q: If we experienced a pandemic or public emergency situation, like the SARS outbreak for example, how prepared do you think the Canadian public health system would be to deal with it? Would it be very prepared, somewhat unprepared, very unprepared?

Concerned About Another SARS Type Situation Total Concerned Doctors 81% Pharmacists 60% Nurses 85% Managers 91% Q: How concerned are you that this type of situation might occur again? Are you very concerned, somewhat concerned, not very concerned, not at all concerned?

Pharmaceuticals and Pharmacists 45

Pharmaceuticals and Pharmacists è Pharmacists are facing many issues: two of the priority concerns of the profession are - roles for pharmacists in primary health care teams; reimbursement for services other than dispensing medication. è 77% of the public, 95% of pharmacists, 77% of nurses and 88% of managers believe that pharmacists should have access to patients lab results and diagnostic tests to verify prescribed medication is most appropriate. Only 45% of physicians support this idea.

Pharmaceuticals and Pharmacists è Canadians believe that all Canadians should have access to all needed medications – 92% feel that government drug plans should cover any medication that a patient and their doctor agree are the most effective treatment and 87% believe if one province provides a drug that other provinces should automatically cover it as well. è 84% of Canadians believe there should be a maximum people should have to personally pay out of their own pocket for drug costs. è 80% of Canadians believe that people take too many medications but 71% also believe there are many people who should be taking medication regularly are not.

Pharmaceuticals and Pharmacists è 77% of Canadians believe that prices for drugs have to be competitive with the rest of the world to attract research and development (R&D) to Canada. è About two thirds of physicians believe that formulary restrictions interfere with their ability to provide necessary care, and more than 80% consider whether a patient’s insurance coverage when making prescribing choices.

Issues Facing the Pharmacy Profession Mean Score Max=10 Roles for pharmacists in primary health care teams 8. 5 Continuing education needs 8. 4 Reimbursement for services other than dispensing 8. 4 Working conditions 8. 0 Supply and distribution of pharmacies & pharmacists 7. 5 Prescribing rights for pharmacists 7. 3 Credentialing of pharmacy technicians 6. 8 Internationally trained pharmacists practising in Canada 6. 4 Extremely Important (9, 10) Somewhat Important (7, 8) Moderately Important (5, 6) Somewhat Not At All Don't Know/ Not Important (3, 4) Important (1, 2) Refused Q: On a scale from 1 to 10 where ten means extremely important and one means not at all important, how important do you think the following issues are for the profession of pharmacists? (READ AND ROTATE) BASE: Pharmacists

Giving Pharmacists Access To Patients’ Lab Values and Diagnoses Total Agree 77% Public 45% Doctors 95% Pharmacists 77% Nurses 88% Managers Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: Do you strongly agree, somewhat disagree or strongly disagree that pharmacists should have access to patients’ lab results and diagnoses in order to verify that a prescribed medication is the most appropriate and effective for that individual?

Pharmaceuticals Total Agree Govt. drug plans should include coverage for any medications that a patient and their doctor agree are the most effective treatment If a drug is covered by one province, it should automatically be covered by other provinces Governments should ensure that there is a maximum limit to how much individuals should have to personally pay for drug costs Generally, patients take too many medications Pharmaceutical prices in Canada need to be competitive with the rest of the world to attract R&D funding to Canada Many patients who should be taking medication regularly are not The Canadian drug approval system is faster than the systems in other countries Strongly Agree 92% 87% 84% 80% 77% 71% 43% Somewhat Agree Somewhat Disagree Strongly Disagree Don’t Know Q: I am going to read you a number of statements, and I’d like you to tell me if you strongly agree, somewhat disagree, or strongly disagree with each. (READ AND RANDOMIZE) BASE: GENPOP

Agreement - Many Patients Who Should Be Taking Medication Regularly Are Not Total Agree Public 71% Doctors 85% Pharmacists 88% Nurses 82% Managers 80% Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: I am going to read you a number of statements, and I’d like you to tell me if you strongly agree, somewhat disagree, or strongly disagree with each. A) Many patients who should be taking medications regularly are not

Agreement - Canadian Drug Approval System Is Faster Than Other Countries Total Agree Public 43% Doctors 27% Pharmacists 36% Nurses 28% Managers 21% Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: I am going to read you a number of statements, and I’d like you to tell me if you strongly agree, somewhat disagree, or strongly disagree with each. B) The Canadian drug approval system is faster than the systems in other countries.

Agreement – Pharma. Prices in Canada Need to Be Competitive to Attract R&D Funding Total Agree Public 77% Doctors 75% Pharmacists 69% Nurses 80% Managers 56% Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: I am going to read you a number of statements, and I’d like you to tell me if you strongly agree, somewhat disagree, or strongly disagree with each. C) Pharmaceutical Prices in Canada need to be competitive with the rest of the world in order to attract research and development funding to Canada

Agreement – Govt Drug Plans Should Include Coverage For Any Medications Deemed to Be Most Effective Treatment Total Agree 92% Public 81% Doctors 64% Pharmacists 90% Nurses 62% Managers Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: I am going to read you a number of statements, and I’d like you to tell me if you strongly agree, somewhat disagree, or strongly disagree with each. D) Government drug plans should include coverage for any medications that a patient and their doctor agree are the most effective treatment.

Agreement – Effects of Pharma. Care Total Agree When prescribing medications, I consider whether the patient has private coverage or can afford to pay for drugs not covered by Pharma. Care 84% Pharmacare formulary restrictions interfere with my ability to provide medically necessary care to my patients 63% Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: (PHYSICIANS ONLY) I am going to read you a number of statements, and I’d like you to tell me if you strongly agree, somewhat disagree, or strongly disagree with each.

Role of Public Vs Private Insurance 57

Private Insurance and Delivery è 45% of those surveyed had heard of the Supreme Court re: private health insurance (55% of men and 37% of women). è Of those who had heard of the ruling 59% said they agreed with it (men 65%, women 49%). è 45% of the public, 49% of nurses, 48% of managers, 72% of pharmacists and 73% of physicians support the idea that Canadians should be allowed to pay out of pocket to purchase faster access to health services that are currently funded under the public system.

Private Insurance and Delivery è When asked whether they would personally be willing to pay out of pocket to purchase faster access to health services that are currently funded under the public system support came from 49% of the public, 60% of nurses, 63% of managers, 74% of physicians and 76% of pharmacists. è A majority of Canadians believe that allowing expanded private insurance will: create a two tier health care system (68%); lead to a shortage of physicians in the public system (61%); and increase costs (58%) è But they also believe it would: result in shorter waiting times (68%); provide better access to health care (59%); improve quality (60%).

Private Insurance and Delivery è 57% of Canadians believe allowing the purchase of private insurance for health care services already covered under the public health system, would have either no impact or a positive impact of the decision on the Canadian health system. è Other groups have a wide range of opinion with 71 % of physicians, 68% of pharmacists, 46% of nurses and 43% of managers feeling that allowing private insurance purchase would have either no impact, or a positive impact on the system. è 57% of the public support allowing individuals to pay out -of-pocket for service enhancements beyond a basic service level (such as upgraded quality prosthetic joints).

Views on Paying for Quicker Access Public Doctors Pharmacists Nurses Managers Q: Do you think that Canadians should be allowed to pay out of pocket to purchase faster access to health services that are currently funded under the public system?

Views on Paying for Quicker Access Q: Do you think that Canadians should be allowed to pay out of pocket to purchase faster access to health services that are currently funded under the public system? BASE: GENPOP

Personally Willing to Pay for Quicker Access Public Doctors Pharmacists Nurses Managers Q: Would you personally be willing to pay out of pocket for your family to purchase faster access to health services that are currently funded under the public system?

Personally Willing to Pay for Quicker Access Q: Would you personally be willing to pay out of pocket for your family to purchase faster access to health services that are currently funded under the public system? BASE: GENPOP

Heard of Supreme Court Ruling Q: In June 2005, the Supreme Court ruled that the Quebec government could not prevent Quebecers from purchasing private insurance for Health Care services already covered under public health insurance programs. Have you heard about this ruling? BASE: GENPOP 65

Agreement with Supreme Court Ruling Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: Do you strongly agree, somewhat disagree or strongly disagree with this decision? BASE: Those who had heard of the ruling n = 553 66

Impact of Private Insurance for Health Care Services Already Covered Under Public System You and your family The Canadian public in general The Canadian health care system Canadian employers who provide health care coverage for their employees Very Positive Q: Somewhat Positive No Impact Somewhat Negative Very Negative Don't Know/ Refused In your opinion, if Canadians were allowed to purchase private insurance for Health Care services already covered under the public health system, would the impact of the decision be very positive, somewhat negative, very negative or would it have no impact on the following? (READ AND ROTATE) BASE: GENPOP

Impact of Private Insurance On You and Your Family Very Positive Somewhat Positive No Impact Somewhat Negative Very Negative Don't Know/ Refused Q: In your opinion, if Canadians were allowed to purchase private insurance for Health Care services already covered under the public health system, would the impact of the decision be very positive, somewhat negative, very negative or would it have no impact on: - You and Your Family BASE: GENPOP

Impact of Allowing Private Insurance on Total the Canadian Public in General Positive Impact 47% Public 66% Doctors 61% Pharmacists Nurses 34% Managers 39% Very Positive Somewhat Positive No Impact Somewhat Negative Very Negative Don't Know/ Refused Q: In your opinion, if Canadians were allowed to purchase private insurance for Health Care services already covered under the public health system, would the impact of the decision be very positive, somewhat negative, very negative or would it have no impact on: The Canadian public in general?

Impact of Allowing Private Insurance on Total the Canadian Health Care System Positive Impact 51% Public 63% Doctors 61% Pharmacists Nurses 36% Managers 40% Very Positive Somewhat Positive No Impact Somewhat Negative Very Negative Don't Know/ Refused Q: In your opinion, if Canadians were allowed to purchase private insurance for health care services already covered under the public health system, would the impact of the decision be very positive, somewhat negative, very negative or would it have no impact on: The Canadian health care system?

Impact of Private Insurance for Health Care Services Already Covered Under Total Public System Agree 68% Create a two-tier system where those who can afford to pay will get better treatment than those who can’t Lead to a shortage of doctors and nurses in the public system, as they leave to work in a new private 61% 68% Result in shorter waiting times Improve access to health care services for everyone 59% Result in increasing costs of health care 58% Lead to improved quality in health care services 60% Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: Do you strongly agree, somewhat disagree or strongly disagree that such a decision would: (READ AND ROTATE) BASE: GENPOP

Allowing Private Insurance For Health Care Would Improve Access To Health Care Services For Everyone Total Agree Public 59% Doctors 68% Pharmacists 43% Nurses 39% Managers Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: Do you strongly agree, somewhat disagree or strongly disagree that such a decision would: Improve access to health care services for everyone?

Allowing Private Insurance For Health Care Would Create a Two-Tier System Total Agree Public 68% Doctors 61% Pharmacists 71% Nurses 75% 71% Managers Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: Do you strongly agree, somewhat disagree or strongly disagree that such a decision would: create a two-tier system where those who can afford to pay will get better treatment than those who can’t?

Allowing Private Insurance For Health Care Would Result in Increasing Costs of Health Care Total Agree Public 58% Doctors 45% Pharmacists 51% 58% Nurses 54% Managers Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: Do you strongly agree, somewhat disagree or strongly disagree that such a decision would: Result in increasing costs of health care?

Allowing Private Insurance For Health Care Would Result in Shorter Waiting Times Total Agree Public 68% Doctors 72% Pharmacists 86% 70% Nurses 64% Managers Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: Do you strongly agree, somewhat disagree or strongly disagree that such a decision would: Result in shorter waiting times?

Allowing Private Insurance For Health Care Would Lead To Improved Quality in Health Care Services Total Agree Public 60% Doctors 63% Pharmacists 75% 46% Nurses 44% Managers Strongly Agree Q: Somewhat Agree Somewhat Disagree Strongly Disagree Don’t Know Do you strongly agree, somewhat disagree or strongly disagree that such a decision would: Lead to improved quality in health care services?

Allowing Private Insurance For Health Care Would lead to Shortages of Doctors and Nurses in Public System Total Agree Public 61% Doctors 43% Pharmacists 63% 72% Nurses 60% Managers Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: Do you strongly agree, somewhat disagree or strongly disagree that such a decision would: Lead to a shortage of doctors and nurses in the public system, as they leave to work in a new private system?

Support for Paying Out-of-Pocket For Service Enhancements Q: In July, Alberta proposed allowing individuals to pay out-of-pocket for service enhancements beyond a basic service level (such as upgraded quality prosthetic joints). Would you like to see this implemented in your province? BASE: GENPOP

Support for Paying Out-of-Pocket For Service Enhancements Q: In July, Alberta proposed allowing individuals to pay out-of-pocket for service enhancements beyond a basic service level (such as upgraded quality prosthetic joints). Would you like to see this implemented in your province? BASE: GENPOP

Support for Paying Out-of-Pocket For Service Enhancements Q: In July, Alberta proposed allowing individuals to pay out-of-pocket for service enhancements beyond a basic service level (such as upgraded quality prosthetic joints). Would you like to see this implemented in your province? BASE: GENPOP

Support for Private Insurance and Payment For Non-Emergency Services Outside of the Public System Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: The Alberta government recently proposed that private insurance and payment be allowed for services that are non-emergency outside of the public system. Do you strongly agree, 81 somewhat agree, somewhat disagree or strongly disagree with this proposal? BASE: GENPOP

Support for Private Insurance and Payment For Non-Emergency Services Outside of the Public System Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: The Alberta government recently proposed that private insurance and payment be allowed for services that are non-emergency outside of the public system. Do you strongly agree, 82 somewhat agree, somewhat disagree or strongly disagree with this proposal? BASE: GENPOP

Support for Private Insurance and Payment For Non-Emergency Services Outside of the Public System Strongly Agree Somewhat Disagree Strongly Disagree Don’t Know Q: The Alberta government recently proposed that private insurance and payment be allowed for services that are non-emergency outside of the public system. Do you strongly agree, 83 somewhat agree, somewhat disagree or strongly disagree with this proposal? BASE: GENPOP

Canadians’ Views on Dealing with Health Care Shortfalls Total Support Oppose 2005 19% 77% Restricting the Range of Services That Are Offered 2004 21% 73% 2003 19% 76% 2005 30% 68% 34% 62% 39% 58% 2005 43% 54% Health Care Tax Linked to 2004 Income 41% 55% 2003 46% 51% Asking Patients to Pay for 2004 Part of the Cost of Services 2003 Q: In order to manage health care spending more effectively, would you strongly support, oppose or strongly oppose each of the following choices? (READ AND ROTATE) BASE: GENPOP

Attitude Towards Working in a Privately Funded Medical Environment Total Enthusiastic Opposed Doctors 41% 27% Pharmacists 36% 12% Nurses 32% 34% Managers 31% 22% Very Enthusiastic Somewhat Enthusiastic Neutral Somewhat Opposed Very Opposed DK/Ref. Q: How would you personally feel about working in a privately funded medical environment. Would you be very enthusiastic, somewhat opposed, very opposed or neutral?

Reasons for Being Enthusiastic About Working in a Privately Funded Medical Environment Doctors Pharmacists Nurses Managers Improved quality of care 35% 19% 23% 19% Better working environment 25% 23% 22% 24% Less Govt. Involvement/ regulation 14% 8% 8% 16% Faster service/shorter waiting times 14% 7% 2% 5% Health care providers salaries/wages 13% 14% 6% 5% Already working in private sector 5% 10% 13% 3% More financing/less cost restraints 4% 12% 2% 16% Q: Why is this? BASE: Those enthusiastic about working in a privately funded medical environment

Reasons for Being Neutral About Working in a Privately Funded Medical Environment Doctors Pharmacists Nurses Managers Makes no difference 32% 38% 25% 40% Will create a two-tier system 12% 2% 3% 3% Depends on outcome 12% 5% 10% 4% Pros and cons for both systems 8% 7% 5% 6% Satisfied with current system 8% 5% 0% 1% Need more information 5% 9% 8% 11% Already work in private system 3% 11% 5% 4% Depends on working environment/conditions 3% 6% 11% 15% Q: Why is this? BASE: Those neutral about working in a privately funded medical environment

Reasons for Being Opposed To Working in a Privately Funded Medical Environment Doctors Pharmacists Nurses Managers Unfair/two-tier/not universal 43% 56% 46% 38% Prefer public sector/don’t change 23% 20% 17% 22% No improvements/decline in quality of care 16% 4% 6% 11% System abuse/unrealistic patient demands 6% 0% 3% 2% Personal experience/worked in private sector 4% 0% 7% 2% Against my principals/ethics 4% 0% 10% 7% Private sector in it for the money 2% 4% 3% 9% Mismanagement concerns 0% 8% 3% 4% Q: Why is this? BASE: Those opposed to working in a privately funded medical environment

Transforming the Health Care System/Innovation 89

Innovation and Research è The following initiatives were all supported by a majority of Canadians: developing more home and community care programs (81%); implementing electronic patient records (61%); increasing the use of non-physician health providers (55%); allowing the government to contract out the delivery of publicly covered services to private clinics (55%). è All groups supported requiring health professionals to work in teams: public (76%), pharmacists (88%), nurses (81%), managers (90%), physicians (52%). è Requiring health professionals to work in parts of the country where they are most needed was supported by 67% of the public, 56% of pharmacists, 50% of nurses and 56% of managers. Only 27% of physicians supported this option.

Innovation and Research è There continues to be very strong and growing support for: n Increased public sector funding for health research public (83%) physicians (85%), pharmacists (93%), nurses (90%), managers (87%) n Incentives to encourage more private sector investment in health research - public (85%) physicians (86%), pharmacists (90%), nurses (85%), managers (87%). è Also 84% to 90% of all groups indicate support for structuring regulatory and pricing systems to encourage research into and rapid development of new vaccines.

Increase Public Sector Funding for Health Research Total Agree Public Doctors Pharmacists Nurses Managers 83% 81% 83% 85% 86% 82% 93% 88% 75% 90% 82% 81% 87% 84% 80% 2005 2004 2003 2005 2004 2003 Strongly Agree Neutral Disagree Strongly Disagree DK/Ref. Q: Health research can include research into medical treatments as well as the best ways to provide care and manage the health care system. Would you say that you strongly agree, are neutral, disagree, or strongly disagree with the following statements: (READ AND ROTATE) There should be increased public sector funding for health research, such as at universities, teaching hospitals and other not-for-profit organizations.

Incentives to Encourage More Private Sector Investment Total Agree Public Doctors Pharmacists Nurses Managers 85% 70% 76% 86% 79% 75% 90% 86% 78% 85% 78% 69% 87% 75% 70% 2005 2004 2003 2005 2004 2003 Strongly Agree Neutral Disagree Strongly Disagree DK/Ref. Q: Health research can include research into medical treatments as well as the best ways to provide care and manage the health care system. Would you say that you strongly agree, are neutral, disagree, or strongly disagree with the following statements: (READ AND ROTATE) Incentives should be put in place to encourage more private sector investments in health research such as at universities, teaching hospitals and other charitable organizations

Systems Should Be Put In Place To Encourage R&D Into New Vaccines Total Agree Public 84% Doctors 89% Pharmacists 85% Nurses 90% Managers 88% Strongly Agree Neutral Disagree Strongly Disagree DK/Ref. Q: Health research can include research into medical treatments as well as the best ways to provide care and manage the health care system. Would you say that you strongly agree, are neutral, disagree, or strongly disagree with the following statements: (READ AND ROTATE) Regulatory and pricing systems should be structured to encourage research into and rapid development of new vaccines.

Support for Initiatives to Improve the Total Health Care System Support Developing more home and community care programs 81% Implement electronic patient records to improve integration of services and monitor resource use 61% Increasing the use of nonphysician health providers when a similar outcome can be achieved at lower cost 55% Allowing the Govt. to contract out the delivery of publicly covered services to private clinics 55% Paying to promote wellness and prevent disease Strongly Support (9, 10) Somewhat Support (7, 8) 54% Neutral (5, 6) Somewhat Oppose (3, 4) Strongly Oppose (1, 2) Don't Know/ Refused Q: I am going to read you a list of initiatives that may lead to a better health system. Thinking of how effective these might be, I would like you to tell me if you would support or oppose the implementation of any of these, using a 10 -point scale where 1 means that you strongly oppose and 10 means you strongly support each one (READ AND ROTATE) BASE: GENPOP

Support for Contracting Out Services Total Support 55% Public 64% Doctors 64% Pharmacists Nurses 44% Managers 58% Strongly Support (9, 10) Somewhat Support (7, 8) Neutral (5, 6) Somewhat Oppose (3, 4) Strongly Oppose (1, 2) Don't Know/ Refused Q: I am going to read you an initiative that may lead to a better health system. Thinking of how effective it might be, I would like you to tell me if you would support or oppose the implementation of it using a 10 -point scale where 1 means that you Strongly oppose and 10 means you strongly support it: Allowing the government to contract out the delivery of public covered services to private clinics, for instance having public health insurance pay for knee surgery at a private clinic rather than a public hospital.

Support for Requiring Patients to Register With One Family Doctor Total Support 62% Public 40% Doctors Pharmacists 71% Nurses 67% Managers 64% Strongly Support (9, 10) Somewhat Support (7, 8) Neutral (5, 6) Somewhat Oppose (3, 4) Strongly Oppose (1, 2) Don't Know/ Refused Q: And to what extent would you support or oppose each of the following policies to increase access to health professionals? - Requiring patients to register with one family doctor?

Support For Requiring Health Professionals To Work In Teams With Other Types of Health Care Providers Total Support 76% Public Doctors 52% Pharmacists 88% Nurses 81% Managers 90% Strongly Support (9, 10) Somewhat Support (7, 8) Neutral (5, 6) Somewhat Oppose (3, 4) Strongly Oppose (1, 2) Don't Know/ Refused Q: And to what extent would you support or oppose each of the following policies to increase access to health professionals? - Requiring health professionals to work in teams with other types of health care providers?

Support For Requiring Health Professionals To Work In Parts of the Country Where They Are Most Needed Total Support 67% Public Doctors 27% Pharmacists 56% Nurses 50% Managers 56% Strongly Support (9, 10) Somewhat Support (7, 8) Neutral (5, 6) Somewhat Oppose (3, 4) Strongly Oppose (1, 2) Don't Know/ Refused Q: And to what extent would you support or oppose each of the following policies to increase access to health professionals? - Requiring health professionals to work in the parts of the country where they are most needed?

Barriers to Inter-Disciplinary or Integrated Patient Care Lack of shared information Too difficult to communicate in real time Physical location of health professionals “Turf wars” over patient information Lack of financial incentive for health professionals Doctors Pharmacists Nurses Managers Patient confidentiality may be compromised Too time-consuming to collaborate Q: In your opinion, how significant is the role that each of the following potential barriers plays in preventing inter-disciplinary or integrated patient care? Please answer using a scale from 1 to 10 where 1 is not at all significant and 10 is extremely significant: (READ AND ROTATE) 100

Barriers to Inter-Disciplinary or Integrated Patient Care – Lack of Shared Information Doctors Pharmacists Nurses Managers Extremely Significant (9, 10) Somewhat Significant (7, 8) Moderately Significant (5, 6) Somewhat Not at all Don't Know/ Insignificant (3, 4) significant (1, 2) Refused Q: In your opinion, how significant is the role that each of the following potential barriers plays in preventing inter-disciplinary or integrated patient care? Please answer using a scale from 1 to 10 where 1 is not at all significant and 10 is extremely significant: Lack of shared information

Barriers to Inter-Disciplinary or Integrated Patient Care – Too Difficult To Communicate In Real-Time Doctors Pharmacists Nurses Managers Extremely Significant (9, 10) Somewhat Significant (7, 8) Moderately Significant (5, 6) Somewhat Not at all Don't Know/ Insignificant (3, 4) significant (1, 2) Refused Q: In your opinion, how significant is the role that each of the following potential barriers plays in preventing inter-disciplinary or integrated patient care? Please answer using a scale from 1 to 10 where 1 is not at all significant and 10 is extremely significant: Too difficult to communicate in real-time.

Barriers to Inter-Disciplinary or Integrated Patient Care – Physical Location of Health Professionals Doctors Pharmacists Nurses Managers Extremely Significant (9, 10) Somewhat Significant (7, 8) Moderately Significant (5, 6) Somewhat Not at all Don't Know/ Insignificant (3, 4) significant (1, 2) Refused Q: In your opinion, how significant is the role that each of the following potential barriers plays in preventing inter-disciplinary or integrated patient care? Please answer using a scale from 1 to 10 where 1 is not at all significant and 10 is extremely significant: Physical location of health professionals

Barriers to Inter-Disciplinary or Integrated Patient Care – “Turf Wars” Over Patient Information Doctors Pharmacists Nurses Managers Extremely Significant (9, 10) Somewhat Significant (7, 8) Moderately Significant (5, 6) Somewhat Not at all Don't Know/ Insignificant (3, 4) significant (1, 2) Refused Q: In your opinion, how significant is the role that each of the following potential barriers plays in preventing inter-disciplinary or integrated patient care? Please answer using a scale from 1 to 10 where 1 is not at all significant and 10 is extremely significant: “Turf wars” over patient information

Barriers to Inter-Disciplinary or Integrated Patient Care – Lack of Financial Incentive Doctors Pharmacists Nurses Managers Extremely Significant (9, 10) Somewhat Significant (7, 8) Q Moderately Significant (5, 6) Somewhat Not at all Don't Know/ Insignificant (3, 4) significant (1, 2) Refused In your opinion, how significant is the role that each of the following potential barriers plays in preventing inter-disciplinary or integrated patient care? Please answer using a scale from 1 to 10 where 1 is not at all significant and 10 is extremely significant: Lack of financial incentive for health professionals

Barriers to Inter-Disciplinary or Integrated Patient Care – Patient Confidentiality May Be Compromised Doctors Pharmacists Nurses Managers Extremely Significant (9, 10) Somewhat Significant (7, 8) Moderately Significant (5, 6) Somewhat Not at all Don't Know/ Insignificant (3, 4) significant (1, 2) Refused Q: In your opinion, how significant is the role that each of the following potential barriers plays in preventing inter-disciplinary or integrated patient care? Please answer using a scale from 1 to 10 where 1 is not at all significant and 10 is extremely significant: Patient confidentiality may be compromised.

Barriers to Inter-Disciplinary or Integrated Patient Care – Too Time-Consuming to Collaborate Doctors Pharmacists Nurses Managers Extremely Significant (9, 10) Somewhat Significant (7, 8) Moderately Significant (5, 6) Somewhat Not at all Don't Know/ Insignificant (3, 4) significant (1, 2) Refused Q: In your opinion, how significant is the role that each of the following potential barriers plays in preventing inter-disciplinary or integrated patient care? Please answer using a scale from 1 to 10 where 1 is not at all significant and 10 is extremely significant: Too time-consuming to collaborate

Key Benefit of An Integrated Electronic Health Record for Doctors Faster Access to Information Easier/Access to Patient Info. Good Thing/Convenient/Efficient Improve Quality of Care Improve Communication/Collaboration Complete Info/Records/History Avoid Duplicatn/Double Doctoring See Medication Hist/Abuse/Intrctions Access From Any Location Fewer Errors Accurate/Up-To-Date Info. Consistency/Continuity of Care Other None/Don't Agree with it Don't Know/Refused Q: What do you believe will be the key benefit of an integrated electronic health record for your practice? BASE: Doctors

Key Benefit of An Integrated Electronic Health Record for Pharmacists Improve Quality of Care Easier/Access to Patient Info. See Medication Hist/Abuse/Intrctions Complete Info/Records/History Faster Access to Information Avoid Duplication/Double Doctoring Good Thing/Convenient/Efficient Fewer Errors Improve Communication/Collaboration Accurate/Up-To-Date Info. Consistency/Continuity of Care Other None/Don't Agree with it Don't Know/Refused Q: What do you believe will be the key benefit of an integrated electronic health record for your practice? BASE: Pharmacists

Key Benefit of An Integrated Electronic Health Record for Nurses Faster Access to Information Improve Quality of Care Easier/Access to Patient Info. Good Thing/Convenient/Efficient Improve Communication/Collaboration Complete Info/Records/History Access From Any Location Avoid Duplication/Double Doctoring Accurate/Up-To-Date Info. Consistency/Continuity of Care See Medication Hist/Abuse/Intrctions Fewer Errors Other None/Don't Agree with it Don't Know/Refused Q: What do you believe will be the key benefit of an integrated electronic health record for your practice? BASE: Nurses

Key Benefit of An Integrated Electronic Health Record for Managers Faster Access to Information Improve Quality of Care Improve Communication/Collaboration Avoid Duplication/Double Doctoring Easier/Access to Patient Info. Complete Info/Records/History Good Thing/Convenient/Efficient Accurate/Up-To-Date Info. Fewer Errors Reduction of Cost Access From Any Location Consistency/Continuity of Care See Medication Hist/Abuse/Interactions Other Don't Know/Refused Q: What do you believe will be the key benefit of an integrated electronic health record? BASE: Managers

Ensuring Accountability 112

Awareness of Health Council of Canada Awareness has increased since 2004 when 27% of the public were aware of the Health Council of Canada Q: In 2004 the Health Council of Canada was formed to report to Canadians on the progress of health reforms in Canada. Have you heard of the Health Council of Canada?

Experience Vs. Perceptions, and Behaviour 114

Recent Health Care Experience Visited your family doctor Visited a hospital emergency room Visited a walk-in clinic Been hospitalised Had surgery Undergone alternative therapy treatments e. g. Acupuncture Received homecare Entered a long-term care facility Q: Have you personally, or a family member, sought medical advice for a health problem in the last 12 months in one of the following ways. Have you or a member of your immediate family: (READ, ACCEPT ALL MENTIONS) Base: GENPOP

Long-Term (Chronic) Illness Q: Do you or a member of your immediate family suffer from a long-term (chronic) illness lasting for more than 6 months? Base: GENPOP

Volunteering Time or Financial Support Health Care Time Support Service Time Financial Support for Health Care Financial Support for Other Services All of the Above No, None Q: In the last year did you volunteer your time or financial support to help an ill relative or friend by providing health care services, for example surgical wound care, or other support services such as homemaking services? Base: GENPOP

Most Suitable Term for Describing People Who Use Health Care Services Public Doctors Pharmacists Nurses Managers Q: Which of the following do you think is the most suitable term for describing people who use the health care service? Customer, client or patient? 118

Health Care in Canada Survey 2005