“Most Canadians Report They Are in Good Health, But Challenges with Chronic Disease Are Increasing” Deloitte Survey of Health-care Consumers in Canada

Aug 16, 2011 | Corporate Member News

Deloitte report reveals that the use of preventive services is widespread and interest in electronic tools is high

55% of Canadians rate their overall health as “excellent” or “very good” in 2011—a decline from 2009 when 60% said the same— and nearly two-thirds report high levels of emotional well-being, similar to two years ago. At the same time, Canadians are experiencing increased challenges as they try to adequately address wellness, healthy living and chronic disease. For example, over half of Canadians have been diagnosed with one or more chronic diseases. These are some of the findings of Deloitte’s 2011 Survey of Health-care consumers in Canada: Key findings, strategic implications which surveyed over 2,300 adult Canadians to better understand the perspectives of Canadians as health care consumers.

“While we note a decline compared to two years ago, the fact that a majority of Canadians continue to rate themselves as healthy is good news. Our survey shows we rank third in that self-assessment, just behind the U.S. (61%) and the U.K. (56%), and well ahead of the other nine countries we reviewed,” says Mark Fam, Senior Manager, Deloitte National Health Services and lead author for the Canadian health consumer survey. “This is consistent with other findings in our study that indicate Canadians are generally satisfied with their health care system. However, we also see an increase in consumer demand for improvements to system performance and their access to health services that support their own wellness and care self- management.”

But the new survey results also reveal major challenges, including increasing rates of chronic disease (52% this year compared to 47% in 2009), a development with significant implications in terms of health outcomes and income-generating capacity for many Canadians.

“The number of Canadians giving high marks to their health climbs sharply (over 70%) if we only look at those without chronic disease,” Fam said. “In addition, one in seven Canadians now have responsibility for the care of family members or friends, an increase from 2009. Fam pointed out that this trend is growing and it represents major limitations on the caregivers’ ability to earn income. “This is a challenge that continues to be a key element of the Canadian consumer health care experience,” Fam indicated.

Now in its fourth year globally, and the second year for Canada, the 2011 survey continues to explore consumers’ behaviours, attitudes, and unmet needs in six areas: wellness and healthy living; information resources; traditional health services; alternative health services; health insurance; health policy.

The new survey found that Canadians are experiencing a range of difficulties – from costs to information in order to fully navigate the system – in finding the resources they need to achieve effective self-care. As a result, survey respondents were in favour of innovations and solutions that help them manage their own care and that bring the health-care system as close as possible to the individual in order to meet evolving needs and expectations.

In commenting on these findings, Lisa Purdy, Partner, National Health Leader, Deloitte noted that the increasingly widespread use of preventive services—regular check-ups, screenings, supplements, nutritional foods—is a step in the right direction but that it needs to be enhanced with targeted encouragements such as tax-based incentives to promote healthy living.

“Currently, women and older Canadians use preventive services the most, but younger Canadians indicate they would welcome new public tax models that reward healthy living,” Purdy said.

She also emphasized the high interest shown by Canadians toward electronic tools that help manage their care and consolidate related information: over 65% of Canadians said they would favour having a government-provided electronic health record that could be used by themselves and their health providers; a similar number support medical devices that enable them to check their health condition and send information electronically to their doctor.

“A strong majority of Canadians said they used the Internet in the past year for online banking, to purchase merchandise or reserve travel, so this is a trend our health-care system can follow in order to meet the evolving needs of the population.”

Purdy also noted that consumers’ concern over privacy and security of personal information is dropping: fewer than a third of respondents say they are highly concerned about the security of their information stored online this year, compared to 34% two years ago.

Other highlights of the new survey findings include:

Most Canadians believe they are adequately insured across their public and private health insurance.

  • 79% of all respondents are covered by some type of private supplemental health insurance, health plan, or health care program, up from two years ago. Most people have prescription drug coverage, dental, and vision insurance.
  • The economic downturn has altered Canadians’ use of the system: half are now more cautious about spending on health care, and six in 10 feel insecure about their ability to handle future health care costs.
  • Regardless of insurance coverage, consumers are concerned about future health care costs; one-third spent more this year on health care than in 2009, and 40% feel spending on health care limits their household’s ability to spend money on other essential items.

About four in 10 Canadians are positive about the country’s health care system, believing that it is better than many other comparable systems, is of high quality and is technologically advanced; one-third believe it is wasteful. However, Canadians report a low understanding of the health system evaluating the system on their experiences rather than a studied view.

  • Features of the Canadian system that are appreciated or valued by consumers include up-to-date technology, innovation, modern facilities and equipment, and use of electronic health records or EHRs.
  • Consumers are critical of the performance of the health care system in such areas as wait times (57%), access (28%), wellness-orientation (26%), use of EHR (22%), and patient-orientation (22%).
  • Opinion is mixed concerning privatization: around one in five believes that privatization would improve performance whereas one-third does not. Boomers are not enthusiastic about privatization, and consumers with three or more chronic conditions are not convinced that privatization is the solution for improved performance.
  • Health care is a key policy issue for a strong majority of Canadians: just above two-thirds believe it’s an important federal electoral issue while nearly three-quarters indicate it’s important provincially. Increased access is the top policy priority.

The majority of consumers say they would leave their local community for care elsewhere if improved quality or faster access were available

  • While many are open to travelling outside their area for treatment if recommended by their physician (38%)—particularly seniors (48%)—27% of consumers would not. Only 2% report they travelled outside Canada to consult with a doctor, undergo a medical test or procedure, or receive treatment in the last 12 months, although over half say they would consider doing so for necessary hospital procedure like joint replacement or heart surgery or for an elective procedure (40%).
  • The decision to travel outside of Canada for necessary care rests upon factors such as an expectation of superior quality medical care and treatment (75%), availability of the specific treatment needed (74%), lack of waiting times (67%), more up-to-date technologies and facilities than available in Canada (66%), and out-of-pocket costs involved (64%).

Canadians prefer traditional western medicine, but one in four invests in alternative methods

  • 45% of Canadians prefer physicians with an orientation toward traditional medicine; 19% say they consulted a herbalist, homeopath, chiropractor, or other alternative practitioner or adviser in the past year.
  • One quarter of consumers say they delayed or decided not to follow physician recommendations; instead, they chose to use an alternative treatment or natural therapy first.
  • Half of consumers use prescription medications, and three in 10 take over-the-counter medications; confidence is high regarding the safety and effectiveness of both brand and generic drugs.

Canadian consumers trust treatment and safety information from academic health sciences centres and medical associations. Least-trusted sources are pharmaceutical, biotech or medical device/product manufacturers, and health insurance companies/health plans.

  • For information about safe and effective treatments, over half say they trust physicians and academic health sciences centres, while 48% report they turn to community hospitals, 45% to Health Canada, and 45% to pharmacies.
  • Consumers are starting to turn to pharmacists for medication advice; consumer confidence is high regarding the effectiveness of prescription medications, and there is openness to generic drugs.

Regional differences

Canadians across the country are aligned on most issues in the survey. However, a few key differences emerged. For example, only one-third of Quebecers grade Canada’s health system an A or a B compared with just over half in other parts of the country; nearly two-thirds of Ontarians graded their health system an A or a B. Quebecers are also more willing than other Canadians to pay out-of-pocket for private care in exchange for better quality or faster access. The survey also shows that patients in Atlantic Canada experience the most difficulty in accessing a primary care provider. In terms quality of care in Canadian hospitals, Saskatchewan residents are the most satisfied—85%, compared to the Canadian average of close to 75%.

Implications for other health care stakeholders

The following key findings are expected to prompt stakeholders to develop strategies designed to engage consumers in improving their own health and changing their interactions with the system:

  • Canadians want improvements in the health system overall, with a focus on initiatives that increase access to physicians, primary care, community services, and EHRs.
  • Consumers are continuing to differentiate based on quality, service, satisfaction, and the value proposition based on their personal experiences rather than objective analysis of options; cost is not yet a significant part of the consumer perspective.
  • Trust in and support for the public health care system is high; however, views on system performance compared to other countries are acceptable, and consumers recognize they are ill-prepared for increasing roles in caregiving and cost management.
  • Consumers are willing to entertain increased costs for specialized services or enhanced private care if the public health care system is maintained.
  • Consumers want holistic care and resources to pursue wellness and healthy living but need help in realizing effective self-care.
  • Consumers embrace innovations that enhance self-care, convenience, personalization, and control of their personal health information—online tools, Personal Health Record (PHRs) and access to their physicians—to supplement, not replace, trusted provider-patient relationships.

About the survey

A nationally representative sample of 2,304 Canadian adults, aged 18 and older, was surveyed in April 2011 using a web-based questionnaire. The sample was representative of the nation’s population, as reflected in the 2006 census, with respect to age, gender, income, and province. The margin of error is +/- 2.0% at the .95 confidence level.

The survey consisted of 84 questions, with 33 potential follow-up questions. English and French versions were available. Participants were asked about behaviours before attitudes within each topic area to reduce response bias. This year, Deloitte surveyed health care consumers in Belgium, Brazil, Canada, China, France, Germany, Luxembourg, Mexico, Portugal, Switzerland, the United Kingdom, and the United States.

About the Deloitte Center for Health Solutions

The Deloitte Center for Health Solutions (DCHS) is the health services research arm of Deloitte LLP. Our goal is to inform all stakeholders in the health care system about emerging trends, challenges and opportunities using rigorous research. Through our research, roundtables and other forms of engagement, we seek to be a trusted source for relevant, timely and reliable insights.

Learn more about the DCHS, its research projects and events

About Deloitte

Deloitte, one of Canada’s leading professional services firms, provides audit, tax, consulting, and financial advisory services through more than 7,600 people in 57 offices. Deloitte operates in Québec as Samson Bélair/Deloitte & Touche s.e.n.c.r.l. Deloitte & Touche LLP, an Ontario Limited Liability Partnership, is the Canadian member firm of Deloitte Touche Tohmatsu Limited.

Deloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee, and its network of member firms, each of which is a legally separate and independent entity. Please see www.deloitte.com/about for a detailed description of the legal structure of Deloitte Touche Tohmatsu Limited and its member firms.

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