Via the Canadian Institute for Health Research, Canada was an enthusiastic participant in the Commonwealth Fund’s ambitious 18,000-person 2021 survey of seniors in 11 wealthy nations.(Germany, Australia, Switzerland, New Zealand, the U.S., Norway, Canada, the U.K., France, Sweden and Netherlands). It asked 68 questions about people’s experience with and perception of the health-care system and the health-care providers they deal with.
In our recent C.D. Howe Institute paper, we focused on the results for seniors care. We used 49 indicators from the survey to create five summary categories: access to care, care process, equity, the impact of COVID-19 on seniors and the health status of seniors. Such an international comparison allows us to understand where Canada’s health system is doing well and where it needs improvement. The Canadian sample was huge, more than 5,000 respondents, which permitted some regional breakdowns.
Overall, Canada ranked eighth out of 11 countries included in the survey, ahead of only the U.K., France and Sweden. We ranked second last (ahead of only the U.S.) on access to care and were below average for equity. Not one province met the international average for access to care or equity, suggesting that the timeliness of care, access to it and its cost all need to be improved. All provinces except Newfoundland and Labrador did perform at or above the international average in care process, which includes factors such as co-ordination across providers and patient engagement, so that’s something.
In terms of affordability, only P.E.I. is above (though only slightly above) the international average in this sub-category. Newfoundland and Labrador, New Brunswick, B.C., Manitoba and Saskatchewan rank below all comparator countries except the U.S. in terms of affordability of health care for seniors. Fifteen per cent of seniors reported not visiting a dentist and eight per cent said they did not receive the home care they needed due to cost. Addressing access gaps in home care and dental care should be priorities.
Timely access to care is also a challenge across the country, with all provinces ranking below the international average. Saskatchewan and Ontario scored the highest among provinces on this measure, while the Yukon, Newfoundland and Labrador and Quebec rank lowest among all comparator regions.
Our study simulated how achieving the highest international standard would affect our ranking. If we could either improve timeliness and access to health-care visits or reduce cost barriers to pharmaceutical, dental and home care, we would move to fifth out of 11, above the international average. If we managed to do both, we would soar all the way to third.
The “improving access” scenario includes the following goals: having 100 per cent of seniors with a regular health-care provider or a regular place to receive health care (as New Zealand does); having 79 per cent of respondents say they can get an appointment with a nurse or doctor the same or next day (as in Germany); and having only 16 per cent of the population experience difficulty getting after-hours care (as is the case in the Netherlands).
Reaching best performance in terms of cost barriers would mean: only one per cent of older adults skip doses of medicine or don’t fill prescriptions (as in Germany, the Netherlands, New Zealand and the U. K.); only two per cent avoid the dentist (as in Germany and the Netherlands); and only three per cent go without home care due to costs (as in Germany and Sweden).
Too many Canadians are without a regular place or provider of care. And we rank among the lowest in availability of same-day or next-day appointments and highest in difficulty in accessing after-hours care. Improving some of these outcomes is already within reach but others will take more time, investment and policy change to address. For example, at the moment 96 per cent of older Canadians have a regular place or provider of health care; achieving the highest international standard would require matching the remaining four per cent (about 293,000 people) with primary care or designating a place for those without a provider to receive care. Though ambitious, this goal is not impossible and the importance of primary care in managing health-care needs as people age should make it a priority.
Rosalie Wyonch is a senior policy analyst and Tingting Zhang a junior policy analyst at the C.D. Howe Institute.
