Transcript Access to Primary Care

Access to care
Timely access to care
Cost as a barrier to health care
1
Most older Canadians have a regular doctor
96%
of Canadians age 55 and older had 1 or more doctors they usually
went to for their medical care.
How does Canada compare (2014)?
France
Netherlands
Germany
•
Older Canadians were more
likely to have a regular doctor
than younger Canadians.
•
85% of Canadians older than
Norway
Switzerland
Australia
CANADA
96%*
New Zealand
CMWF AVERAGE
United Kingdom
United States
93%
12 had a regular doctor.
Source
Statistics Canada. Table 105-0501—Health indicator
profile, annual estimates, by age group and sex,
Canada, provinces, territories, health regions
(2013 boundaries) and peer groups, occasional.
Sweden
2
Older Canadians wait longest for primary care
53%
waited for at least 2 days to see a doctor or a nurse the last time
they were sick or needed medical attention.
How does Canada compare (2014)?
CANADA
No improvement since 2007
53%*
Norway
2007
United States
Sweden
United Kingdom
CMWF AVERAGE
Australia
32%
53%
Switzerland
Netherlands
Germany
New Zealand
France
Source
The Commonwealth Fund, 2007 International
Health Policy Survey in Seven Countries.
30% of older Canadians waited at least 6 days or gave up (2014).
3
Canadians are least likely to get timely responses
Proportion of older Canadians who
always or often got an answer the same
day when they called their regular
doctor with a medical concern
France
Proportion of older Canadians who
wished to or were able to email their
doctors with a medical question, 2014
25%
Switzerland
United States
New Zealand
Netherlands
4%
United Kingdom
CMWF AVERAGE
72%
Germany
Wished to
Were able to
Sweden
Norway
Australia
CANADA
63%*
In 2012, 11% of family physicians
offered patients the option to email them
about a medical question or concern.
Source
The Commonwealth Fund, 2012 Commonwealth Fund
International Survey of Primary Care Doctors.
4
Canadians have fewer after-hours options
for primary care
51%
thought it was very or somewhat difficult to get medical care in
the evenings and on weekends or holidays without going to the
emergency department (ED).
How does Canada compare (2014)?
CANADA
51%*
United States
Proportion of family physicians
whose practice had an arrangement
for after-hours care
2012
Sweden
Australia
CMWF AVERAGE
Germany
Norway
United Kingdom
29%
45%
New Zealand
Switzerland
France
Netherlands
Source
The Commonwealth Fund, 2012 Commonwealth
Fund International Survey of Primary Care Doctors.
5
Lack of access to timely care has an impact
on ED use
37%
of older Canadians went to an ED for a condition that could have been
treated by their regular doctor.
How does Canada compare (2014)?
United States
CANADA
France
New Zealand
Switzerland
Sweden
CMWF AVERAGE
Norway
Australia
United Kingdom
Germany
Netherlands
37%*
28%
In 2013–2014, 1 in 5 emergency visits in Canada
was for a condition that could have been treated
elsewhere, such as a doctor’s office.
The most common conditions were upper respiratory
infections (13%) and antibiotic therapy (13%).
Source
Canadian Institute for Health Information. Sources of Potentially
Avoidable Emergency Department Visits. Ottawa, ON: CIHI; 2014.
6
Canadians wait longest for specialist care
25%
of older Canadians waited for at least 2 months to see a specialist;
these waits had not improved over time.
How does Canada compare (2014)?
CANADA
Specialist wait times, by year
25%*
Norway
60%
New Zealand
50%
Sweden
40%
Germany
30%
Australia
CMWF AVERAGE
United Kingdom
France
Netherlands
Switzerland
15%
20%
10%
0%
2010
<4 weeks
2013
1 month to <2 months
2014
2 months or longer
United States
Sources
The Commonwealth Fund, 2010 and 2013 Commonwealth Fund International
Health Policy Survey.
7
How do the provinces compare?
The timeliness of primary and specialist care was significantly below the international
average for all Canadian provinces.
Older Canadians (55+) who
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Waited for at least 2 days
to see a doctor
50% 55% 57% 54% 50% 58% 54% 55% 53% 53% 53%
32%
Said it was very or somewhat
difficult to get medical care
after hours
47% 45% 49% 55% 47% 60% 53% 59% 57% 65% 51%
29%
Went to the ED for a condition
that could have been treated
by their regular doctor
30% 39% 33% 34% 39% 38% 42% 37% 40% 50% 37%
28%
Waited for at least 2 months
to see their specialist
24% 28% 32% 32% 24% 25% 29% 27% 28% 34% 25%
15%
Compared with the CMWF average
Above average
Same as average
Below average
8
Is cost a barrier to accessing care?
In Canada’s publicly funded health care system, most older Canadians accessed
the medical care they needed without having to worry about costs.
In the past year
Canada
CMWF average
United States
Did not see a doctor for a medical problem
because of the cost
4%
5%
15%
Skipped a medical test, treatment or follow-up
recommended by a doctor because of the cost
5%
5%
15%
Did not fill a prescription for medicine or skipped
doses of medications because of the cost
7%
4%
15%
15%
N/A
N/A
Did not see a dentist when needed to because
of the cost
Compared with the CMWF average
Above average
Same as average
Below average
Not applicable
9
Cost can be a barrier for prescription drugs
Canada was second to only the United States in the proportion of older people
who did not fill a prescription because of costs.
How does Canada compare (2014)?
Did not fill a prescription for medicine or
skipped doses because of the cost
United States
CANADA
Australia
New Zealand
CMWF AVERAGE
Germany
Netherlands
Switzerland
United Kingdom
Sweden
Norway
France
7%*
4%
Public share of total prescribed drug
spending, 2012 or nearest year
Germany
United Kingdom*
Switzerland
France
New Zealand †
Netherlands
Sweden
CMWF AVERAGE
†
Australia
Norway
CANADA †
United States
Notes
* 2008 data.
† 2011 data.
Source
OECD Health Statistics 2014.
70%
43%
10
Drug costs affect a higher proportion of people
age 55 to 65
1 in 10
Canadians age 55 to 64 did not fill their prescriptions or skipped
their medications because of the cost.
Proportion by age
10%
55–64
5%
65+
Most Canadian provinces have
public drug coverage programs
for seniors age 65+.
11
Cost can be a barrier for dental care
15%
of older Canadians did not receive the dental care they needed
because of the cost.
Proportion who did not receive dental care by age, 2014
19%
55–64
12%
65+
Only 4 jurisdictions (Alberta,
Yukon, the Northwest Territories
and Nunavut) have public oral
health care services for seniors.
Source
Canadian Academy of Health Sciences.
Improving Access to Oral Health Care for
Vulnerable People Living in Canada. Ottawa,
ON: CAHS; 2014.
12
Public coverage of dental care is lower in Canada
Probability of a dental visit,
by income, 2009
Low income
47%
Share of public spending on outpatient
dental care, 2012 or nearest year
High income
79%
Source
Organisation for Economic Co-operation and Development.
Health at a Glance 2013: OECD Indicators. 2013.
Germany
Sweden
New Zealand †
France
Australia†
Norway
CMWF AVERAGE
Netherlands
United States
Switzerland
Canada†
25%
6%
Notes
† 2011 data.
Source
OECD Health Statistics 2014.
13
How do the provinces compare?
Results were generally comparable to the international average. Differences in public
coverage and program design for drug plans may partly explain variation in results
between provinces.
B.C. Alta. Sask. Man. Ont. Que.
N.B.
N.S. P.E.I. N.L. Can. CMWF Avg.
Did not see a doctor for a
medical problem because
of doctor visit costs
4% 4%
3%
3%
4%
3%
5%
3%
5%
4% 4%
5%
Skipped a medical test, treatment
or follow-up recommended by a
doctor because of diagnostic/
treatment costs
3% 4%
2%
4%
7%
4%
5%
5%
4%
6% 5%
5%
Did not fill a prescription for
medicine or skipped doses
of medications because
of prescription costs
8% 6%
2%
7%
8%
7% 12% 7%
8%
7% 7%
4%
Compared with the CMWF average
Above average
Same as average
Below average
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