2005 National Health Care Leadership Conference

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2005 National Health Care Leadership
Conference Saint John, New Brunswick June 6
7, 2005 Presented by
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Health Care in Canada Partners

• Association of Canadian Academic Healthcare
  Organizations
• Canadian Association for Community Care
• Canadian College of Health Service Executives
• Canadian Healthcare Association
• Canadian Homecare Association
• Canadian Medical Association
• Canadian Nursing Association
• Canadian Pharmacists Association
• Canadian Public Health Association
• Health Charities Coalition of Canada
• Merck Frosst Canada Ltd.
• POLLARA Research
• Rogers Media

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Table of Contents
Page

• Methodology 4
• Overview of the Health Care System 5
• Views on the September 2004 Federal-Provincial
  Health Care Deal 13
• Improving Access 16
• Promoting and Protecting Health 25
• Supporting Innovation 27
• Increasing Accountability 37
• Conclusions 42

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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 October 20th and November 3rd, 2004. Key
  questions were updated in May 2005.
• Groups Sample Size Margin of Error
• Canadian Public 1,034 3.1
• Doctors 200 7.1
• Nurses 201 7.1
• Pharmacists 200 7.1
• Health Administrators 210 7.1
• Questionnaires were developed by POLLARA working
  in close consultation with the HCIC partners.

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Overview of the Health Care System
6
Most Important Issue Facing Canada Tracking
Important
28 Health Care
6 Economy
5 Deficit/Govt Spend. Concerns
Politicians
4 Education
3 Unempl. Taxes
Question In your opinion, what is the single
most important issue facing Canada today?
Source Perspectives Canada
7
Very Concerned Tracking
64 Health Care
55 Politicians
49 Education
48 Environment
45 Prov. Taxation
44 Fed. Taxation
43 Trade Disputes with U.S.
36 Natl Resources
29 Crime
28 Cdas Security
25 Cda U.S. Border
Very Concerned
Source Perspectives Canada
Question 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)
8
Tracking of Key Issues May 2005 will include

• Confidence in the Health Care System
• Views on Health Care System Reforms
• Improvements in Access to Care
• Canadians Willingness to Pay

9
Tracking of Canadians Confidence in the Health
Care System
1998 1999 2000 2001 2002 2003 Spring 2004 Fall
2004 Spring 2005
QOverall, 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?
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Canadians Confidence in the Health Care System
Demographics - Spring 2005
QOverall, 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?
Source POLLARA Omnibus - May 05
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Confidence of All Stakeholders in Canadian Health
Care System Fall 2004
Public Doctors Nurses Pharmacists Managers
Question 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?
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Proportion With Falling Confidence in Canadian
Health System is Declining
Question 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?
13
Canadians Views onHealth Care System Reform
1998 1999 2000 2001 2002 2003 2004 Spring 2004
- Fall 2005 - Spring
Complete Rebuilding
Fairly Major Repairs
Minor Tuning Up
Everything's Fine
Q What approach would you say that Canadas
health system requires at present - a complete
rebuilding from the ground up, some fairly major
repairs or some minor tuning up, or is everything
fine the way it is?
Source HCIC 2004 Update POLLARA Omnibus
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Canadians Views on Health CareSystem Reform -
2005
Men Women 18-24 25-34 35-44 45-54 55-64 65
Complete Rebuilding
Fairly Major Repairs
Minor Tuning Up
Everything's Fine
Q What approach would you say that Canadas
health system requires at present - a complete
rebuilding from the ground up, some fairly major
repairs or some minor tuning up, or is everything
fine the way it is?
Source POLLARA Omnibus May 05
15
Views of The Health Care System in Five Nations
- 1998 to 2004
Source The Commonwealth Fund 2004 International
Health Policy Survey of Primary Care in Five
Countries Conducted by Harris Interactive and
subcontractors March May 2004
16
Views on the September 2004 Federal-Provincial
Health Care Deal
17
Impact of Health Deal
Question In your opinion, what impact will the
September 2004 Health Deal reached by the
Premiers and the Prime Ministers have? Do you
think it will significantly improve, improve,
have no impact, worsen or significantly worsen
Canadians access to timely, quality health care?
18
Managers Views on Health CareDeal Funding
Sufficient Money to Address the Capital
Funding Sufficient Money for Wait Times For Key
Services
Q Do you think the healthcare deal recently
agreed upon by the first ministers provides
sufficient dollars to address the capital funding
needs in your region/facility? Q Do you think
the agreement between the first ministers
provides sufficient dollars to address the wait
times for surgeries, diagnostics or other key
services in your region/facility?
19
Improving Access
20
Canadians Satisfaction with Health Care Access
in Home and Community
Total Satisfied 47 48 48 48 49
2000 2001 2002 2003 2004
Question Would you say that you are very
satisfied, somewhat satisfied, somewhat
dissatisfied or very dissatisfied with access to
care in the home or community?
21
Canadians Satisfaction with Health Care Access
in Home and Community Demographics 2004
Question Would you say that you are very
satisfied, somewhat satisfied, somewhat
dissatisfied or very dissatisfied with access to
care in the home or community?
22
Timeliness of Access to Care
Total Satisfied 42 38 43 43 46
2000 2001 2002 2003 Spring 2004
Q Would you say that you are very satisfied,
somewhat satisfied, somewhat dissatisfied or very
dissatisfied with the following aspects of
todays health care system? (READ AND ROTATE) ...
Timeliness of access to care
Source HCIC 2004 - Update
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Canadians More Pessimistic About Improvements in
Access to Care
Total Improved 34 47 37
2002 2003 Spring 2004
Question Over the next five years, do you
believe that Canadians access to timely, quality
health care will significantly improve, improve
somewhat, worsen somewhat or significantly worsen?
Source HCIC 2004 - Update
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Improvements in Access to Care
Total Improve 30
Spring 2005
Q Over the next five years, do you believe that
Canadians access to timely, quality health care
will significantly improve, improve somewhat,
remain the same, worsen somewhat or
significantly worsen?
Source POLLARA Omnibus - May 05
25
Improvements in Access to Care - 2005
TotalImprove 32 29 31 24 24 25 34 48
Men Women 18-24 25-34 35-44 45-54 55-64 65
Q Over the next five years, do you believe that
Canadians access to timely, quality health care
will significantly improve, improve somewhat,
remain the same, worsen somewhat or
significantly worsen?
Source POLLARA Omnibus - May 05
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Summary of Health Care Human Resources
Doctors More Than Enough1 Enough10 Not
Enough89
Nurses More Than Enough1 Enough6 Not
Enough92
Pharmacists More Than Enough1 Enough11 Not
Enough88
Managers More Than Enough4 Enough52 Not
Enough40
General Public Thinks
Question Do you believe that Canada has more
than enough, enough, or not enough of each of the
following skilled health care professionals to
meet our populations needs? (READ AND ROTATE)
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Doctors Views on Solutions to Physician Shortage
Total Effective 88 76 64 69
Increase MedicalSchool Enrolment Better Models
OfHealthcare Delivery More InternationalMedical
Graduates Train DelegateTo Professionals
Question How effective would you say the
following options would be in providing a
sustainable solution to address Canadas
physician shortage very effective, somewhat
effective, not very effective, not at all
effective?
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Doctors View of Role of Physicians Compared to
10 Years Ago
Patients see physicians asprimary HC
provider Physician are now one of many
components, as opposed to the sole source, in
their approach to health and wellness Mass
information and the focus on health awareness has
improved the traditional patient/physician
relationship Mass information and the focus on
health awareness has threatened the traditional
patient/physician relationship
Question Thinking of how patients perceive the
role of physicians today, compared to 10 years
ago, to what extent do you agree with the
following statements, on a 10-point scale where 1
means Totally Disagree and 10 means Totally Agree?
29
Pharmacists View on Role of Pharmacists
Pharmacists should play an integral part in
providing medication services to patients
receiving care at home Pharmacists should have
greater role in choosing the appropriate
prescription medications for patients
Question To what extent do you agree with the
following statements, on a 10-point scale where 1
means Totally Disagree and 10 means Totally Agree
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Promoting and Protecting Health
31
Promotion of Wellness andDisease Prevention
Total Agree 71 64 68 73 55
Public Doctors Nurses Pharmacists Managers
Question Do you strongly agree, somewhat agree,
somewhat disagree or strongly disagree
that Canadians are encouraged/motivated to
promote wellness and prevent disease?
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Supporting Innovation
33
Increase Public Sector Funding for Health Research
Total Agree
2004 2003 2004 2003 2004 2003 2004 2003 2004 2003
81 83
Public Doctors Nurses Pharmacists Managers
86 82
82 81
88 85
84 80
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, 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.
34
Incentives to Encourage More Private Sector
Investment
Total Agree
70 76
2004 2003 2004 2003 2004 2003 2004 2003 2004 2003
Public Doctors Nurses Pharmacists Managers
79 75
78 69
86 78
75 70
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, 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 not-for-profit organizations
35
Support for Contracting Out Publicly Covered
Services
Total Support
2004 2003 2004 2003 2004 2003 2004 2003 2004 2003
53 57
Public Doctors Nurses Pharmacists Managers
66 66
51 58
68 66
61 55
StronglySupport
Support
Oppose
StronglyOppose
DK/Ref.
Question Do you strongly support, support,
oppose or strongly oppose allowing the government
to be able to contract out the delivery of
publicly covered services to private clinics, for
instance having medicare pay for knee surgery at
a private clinic rather than a public hospital?
36
Support for Contracting Out Publicly Covered
Services Demographics
Question Do you strongly support, support,
oppose or strongly oppose allowing the government
to be able to contract out the delivery of
publicly covered services to private clinics, for
instance having medicare pay for knee surgery at
a private clinic rather than a public hospital?
37
Views on Paying for Quicker Access
Total Support 35
Total Support 59
Total Support 41
Total Support 61
Total Support 45
Question Do you strongly support, support,
oppose or strongly oppose individuals being
allowed to pay out of their own pocket for
quicker access to health services that are
currently funded under the public system?
38
Paying for Quicker Access Regional Views
Question Do you strongly support, support,
oppose or strongly oppose individuals being
allowed to pay out of their own pocket for
quicker access to health services that are
currently funded under the public system?
39
Canadians Willing to Pay
Total Yes 69 60 54 56
2002 2003 Spring 2004 Spring 2005
Q Would you be willing to pay more, either
out-of-pocket or tax payments, to increase the
range of services offered or the improve
timeliness of care provided by the health care
system?
Source HCIC 2004 - Update POLLARA Omnibus -
May 05
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Canadians Willing to Pay - 2005
TotalYes 53 59 59 55 54 57 58 59
Men Women 18-24 25-34 35-44 45-54 55-64 65
Q Would you be willing to pay more, either
out-of-pocket or tax payments, to increase the
range of services offered or the improve
timeliness of care provided by the health care
system?
POLLARA Omnibus - May 05
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Canadians Views on Dealing with Health Care
Shortfalls
Total Support
Total Oppose
21 73 19 76
2004 2003 2004 2003 2004 2003 2004 2003
Restricting the Range ofServices That Are
Offered Asking Patients to Pay forPart of the
Cost of Services Health Care Tax Linked to
Income Cut Other Gov. Services and Direct to
Health Care
34 62 39 58
41 55 46 51
65 27 67 28
Question If the governments through taxation
could not cover all of the costs for all health
services, they might have to make choices as to
how to deal with the shortfall. Would you
strongly support, support, oppose or strongly
oppose each of the following choices? (READ AND
ROTATE)
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Support for Innovation in Health Care Delivery
(2004 compared to 2003)
Strongly/Support
n/c
n/c
-3
-6
-1
-1
-8
-5
-3
-6
4
-8
-3
-1
-1
Question Do you strongly support, support,
oppose or strongly oppose each of the following
policies to increase access to health care
professionals? (READ AND ROTATE)
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Increasing Accountability
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Making Sure Every Tax Dollar Intended for Health
Care Is Spent on Health Care
Total Very Good / Good/Fair 55 49 53 55 63
Question Thinking of the additional funding that
will be made available under the new Health Deal,
do you believe that the government will do a very
good, good, fair, poor or very poor job of each
of the following? (READ AND ROTATE) Making sure
that every tax dollar intended for health care
will be spent on health care
45
Reporting to Canadians the Results of How Those
Health Care Dollars Are Spent
Total Very Good / Good 23 25 17 17 26
Question Thinking of the additional funding that
will be made available under the new Health Deal,
do you believe that the government will do a very
good, good, fair, poor or very poor job of each
of the following? (READ AND ROTATE) Reporting to
Canadians the results of how those health care
dollars are spent.
46
Awareness of Health Council of Canada
Question In 2004 the Health Council of Canada
was formed to report to Canadians on the progress
of health reforms in Canada. Their first report
will be in January 2005. Have you heard of this
council?
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Top Priorities for Health Council All
Stakeholders
Question In 2004 the Health Council of Canada
was formed to report to Canadians on the progress
of health reforms in Canada. Their first report
will be in January 2005. What do you think the
priorities of the council should be? (OPEN-ENDED)
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Conclusions
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Conclusions

• Health care remains a top issue of concern for
  Canadians.
• Confidence in the health care system is falling
  for a large proportion of the public.
• Most of the professional stakeholders are not as
  pessimistic as the Canadian public overall
  (except nurses). In fact one-quarter of health
  care managers report raising confidence in the
  system.
• The Federal-Provincial health care deal is viewed
  as an improvement to system, with managers the
  most positive.
• Access remains a concern, with less than half of
  Canadians indicating they are satisfied with
  health care access at home and in community. This
  remains unchanged over the last number of years.
• The majority of Canadians feel that access to
  timely quality health care will remain the same
  or worsen over the next five years.

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Conclusions

• More than half of Canadians continue to say that
  the health care system requires either complete
  rebuilding or fairly major repairs.
• The public and all stakeholder groups say there
  is a shortage of both doctors and nurses in the
  system.
• Canadians (especially doctors and pharmacists)
  appear willing to accept alternative ways to
  deliver health care services, such as contracting
  out certain publicly funded services. They are,
  however, unwilling to accept cuts to services or
  having to pay more, either directly out of pocket
  or indirectly through a health care tax, to fund
  these alternative delivery methods.
• More than half of Canadians are willing to pay
  more to increase timeliness of care or
  increase the range of services.

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Conclusions

• Meanwhile, while Canadians may accept increased
  private involvement in the delivery of services,
  a majority do not support being able to pay to
  jump the queue to receive quicker service.
• Canadians and all providers groups support
  increasing public funding and incentives for
  private funding of health research. Support for
  incentives for private funding has risen for all
  provider groups.
• Canadians are looking for innovative solutions in
  how we deliver care before we seek additional
  personal contribution from them or restrict
  services we offer.
• Canadians feel skeptical about how government
  will in ensuring money assigned for health care
  will be spent on health care, as well as in
  reporting to Canadians how health care dollars
  are spent.

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Conclusions

• Awareness of Health Council is highest among
  health care managers and doctors, and lowest
  among general public.
• Assessing public and provider priorities for the
  Health Council will likely require more
  deliberative approaches combined with public
  polling.
• Canadians are open to reforms and have
  expectations that the new Health Deal will
  improve things.

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Plans for 2005 and beyond

• We hope that the survey results, roundtables, and
  other forums can act as a catalyst for engaging
  the public in discussion on health policy issues.
• August - September We will survey the public,
  physicians, nurses, pharmacists, health care
  managers.
• Accessibility and Innovation Roundtable
  (televised on CPAC) October/November.
• Exploring ways to look at increasing use of the
  Health Care in Canada website
• http//www.hcic-sssc.ca

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Some things we are looking at

• We will continue to look at the following 4 key
  themes
• Improving Access
• Promoting and Protecting Health
• Supporting Innovation
• Increasing Accountability

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The partners are looking to

• Engage the public more and use as a platform to
  champion some success stories
• Explore demographic differences and across
  public/providers.
• Some possible areas of interest
• Defining the Patient of the Future (client,
  customer?)
• Certainty, Safety and Risk in the Health System
• Access Exploring Key Sectors
• Chronic Care What New Approaches Are Needed?
• Ask the tough questions on reforms for the
  future
• Private/public mix in provision and in payment?
• Myth and Reality checks.

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2005 National Health Care Leadership
Conference Saint John, New Brunswick June 6
7, 2005 Presented by