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How Canada Compares:
Results From The Commonwealth Fund 2014
International Health Policy Survey of Older Adults
Report
January 2015
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ISBN 978-1-77109-336-1
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How to cite this document:
Canadian Institute for Health Information. How Canada Compares: Results From The Commonwealth Fund 2014 International Health Policy
Survey of Older Adults. Ottawa, ON: CIHI; 2015.
Cette publication est aussi disponible en français sous le titre Résultats du Canada : Enquête internationale de 2014 auprès des adultes âgés
sur les politiques de santé du Fonds du Commonwealth.
ISBN 978-1-77109-337-8
Table of contents
Acknowledgements
4
About this report
5
Executive summary
7
Methodological notes
12
Access to care
Timely access to care
Cost as a barrier to health care
15
16
23
Caregiving and planning for end-of-life care
Informal caregiving
Planning for end of life and advanced age
29
30
33
Quality of care
Patient-centred primary and specialist care
Medication reviews
Chronic condition management and disease prevention
38
39
44
48
Perception of health and health care
55
Appendix
60
Bibliography
70
3
Acknowledgements
Core funding for The Commonwealth Fund 2014 International Health Policy Survey of Older Adults
was provided by The Commonwealth Fund with co-funding from the following organizations outside
of Canada:
Haute Autorité de santé (France); Caisse nationale de l’assurance maladie des travailleurs salariés
(France); BQS Institute for Quality and Patient Safety (Germany); the German Federal Ministry of
Health; the Dutch Ministry of Health, Welfare and Sport; the Scientific Institute for Quality of
Healthcare, Radboud University Nijmegen (the Netherlands); the Norwegian Knowledge Centre for the
Health Services; the Swedish Ministry of Health and Social Affairs; the Swiss Federal Office of Public
Health; the NSW Bureau of Health Information (Australia); and many other country partners.
Within Canada, funding for an expanded Canadian sample was provided by the Canadian Institute
for Health Information (CIHI), the Canadian Institutes of Health Research (CIHR), the Health Quality
Council of Alberta, the Commissaire à la santé et au bien-être du Québec and Health Quality Ontario.
Production of this document is made possible by financial contributions from Health Canada and
provincial and territorial governments. The views expressed herein do not necessarily represent
the views of Health Canada or any provincial or territorial government.
4
About this report
Health care is fundamentally about people, and the experience of patients is critical to understanding
the performance of a health system. For the past decade, The Commonwealth Fund’s International
Health Policy surveys have helped fill important information gaps through polls of patients and
providers in 11 developed countries. The 2014 edition of this survey focused on the experience of
people age 55 and older.
The purpose of this companion report is to tell the Canadian story, and to highlight how experiences
with health care vary across the country and relative to other countries.
•
For the first time, statistical testing has been performed to understand whether Canadian
results are significantly different from the average of 11 Commonwealth Fund (CMWF)
surveyed countries.
–
In bar graphs, an asterisk (*) indicates that Canadian results are statistically different.
–
Elsewhere in the report where national and provincial results are presented, significance
testing is shown with the following colour codes:
Above average
•
Same as average
Below average
Additional questions that were asked of only Canadian respondents are indicated throughout this
report using a maple leaf.
5
About this report (cont’d)
•
In the body of the report, provincial results are compared with the international average of CMWF
countries. In the appendix, provincial results are compared with the Canadian average.
•
Supplementary data tables with expanded questionnaire information are available as a free
companion product online.
•
To provide additional context, this report also references information from CIHI, Statistics Canada
and other sources. All other data is from the 2014 Commonwealth Fund International Health
Policy Survey of Older Adults.
6
Executive summary
Canada’s demographic realities are not unique. Understanding how to meet the growing health care
needs of an aging population—and how to deliver high-quality care in a cost-efficient fashion—is a
challenge that many other nations are trying to address. When comparing the experiences of older
people in Canada with those of older people in other countries, this report shows significant variation
across the country and mixed results overall.
7
Executive summary (cont’d)
Access to care
Timely access to primary and specialist care remains a significant challenge for
older Canadians.
•
While almost all older Canadians (55 and older) have a regular doctor, 53% waited at least
2 days for care the last time they were sick or needed medical attention, and 25% waited at least
2 months to see a specialist. Canada had the longest waits for primary and specialist care of all
11 countries, and every province had significantly longer waits than the international average.
•
Half of older Canadians found it very or somewhat difficult to get medical care in the evenings and
on weekends or holidays without going to the hospital emergency department (ED). Consequently,
37% of individuals responded that the last time they went to the ED, it was for a condition that
could have been treated by their regular doctor.
•
While cost was not a barrier to medical services for most older Canadians, a significantly higher
proportion (7%) than the average of countries said they were prevented from filling a prescription
or skipped a medical dose because of the cost. For 15% of older Canadians, cost was also a
barrier for dental care.
8
Executive summary (cont’d)
Caregiving and planning for end-of-life care
Older Canadians spent more time on average as informal caregivers; they also spent
more time planning for their own end-of-life needs.
•
Almost 1 in 5 older Canadians provided care at least once a week to a person with an
age-related problem. Nearly half of them (47%) provided care for at least 10 hours a week,
a greater proportion than the international average (40%).
•
Nearly 1 in 4 (23%) Canadian caregivers needed help to provide care but did not receive it,
and 34% said they had experienced distress, anger or depression while providing care.
•
Older Canadians were significantly more likely than older people in other countries to have
discussions (61%) about their end-of life wishes or to have written plans (39%).
9
Executive summary (cont’d)
Quality of care
Generally, older Canadians reported having positive experiences with their providers
that were on par with or better than the international average; however, continuity of care
between providers can be improved.
•
Older Canadians were more likely on average to be encouraged to ask questions (70%) by their
regular doctor and to be involved in treatment plans (79%) by their specialists than older people
in other countries.
•
Most older Canadians were taking multiple medications, and they were significantly more likely to
report having medication reviews (80%) with their care providers than the international average.
•
Older Canadians with chronic conditions were also more likely to have discussions about
treatment goals (60%) and adopting healthy lifestyles (e.g., diet, exercise) with their providers
than older people in other countries. However, only 37% had a written plan to self-manage
their conditions.
•
A higher proportion of older Canadians (13%) said that specialists did not have basic information
or test results from their family doctor. Similarly, 25% said their family doctor did not seem to be
informed and up to date about the specialist care they had received. These results varied widely
across the country, however.
10
Executive summary (cont’d)
Perceptions of health and health care
While older Canadians were more likely to feel good about their health, they were not as
optimistic about their health system.
•
Slightly more than half of older Canadians said their health was very good or excellent,
which was significantly higher than the international average.
•
More than half also believed that fundamental changes are required to fix the health system.
While perceptions of the health system had improved slightly in the previous 7 years, they
were still among the lowest of reporting countries.
11
Methodological notes
The 2014 Commonwealth Fund International Health
Policy Survey of Older Adults randomly sampled the
general population age 55 and older in 11 countries:
Australia, Canada, France, Germany, the Netherlands,
New Zealand, Norway, Sweden, Switzerland, the
United Kingdom and the United States.
Provinces and
territories
Number of
interviews
Percentage
distribution
Newfoundland
and Labrador
252
5%
Prince Edward Island
261
5%
Nova Scotia
258
5%
In Canada, interviews were conducted from March
through May 2014 by Social Science Research
Solutions (SSRS). There were 5,269 respondents.
CIHI and CIHR provided funding to ensure a minimum
of 250 respondents in each province, allowing for
provincial comparisons. Sample sizes were further
increased in Quebec, Ontario and Alberta
with funding from provincial organizations.
The overall response rate in Canada was 28%.
New Brunswick
277
5%
Quebec
1,006
19%
Ontario
1,502
29%
Manitoba
252
5%
Saskatchewan
254
5%
Alberta
953
18%
British Columbia
250
5%
Yukon
3
0%
For a complete list of sample sizes and response
rates from all countries surveyed, please see the
accompanying methodology notes.
Northwest Territories
1
0%
Nunavut
0
0%
5,269
100%
Total
12
Methodological notes (cont’d)
Weighting of results
The survey data for Canada was weighted within each of the 10 provinces by age, gender, level of
education and knowledge of the official language. Additionally, data was subsequently weighted to
reflect Canada’s geographic distribution, by provinces and territories. Population parameters for these
calculations were derived from the 2011 Census.
Averages and trends
For this report, the CMWF average was calculated by adding the results from the 11 countries and
dividing by the number of countries. The Canadian average represents the average experience of
Canadians (as opposed to the mean of provincial results). Except where otherwise noted, results were
compared over time using data from previous CMWF general population surveys for respondents age
55 and older.
Significance testing
CIHI developed statistical methods to determine whether
•
Canadian results were significantly different from the international average of 11 countries;
•
Provincial results were significantly different from the international average; and
•
Provincial results were significantly different from the Canadian average.
An asterisk (*) indicates that results are significantly different on bar graphs, and colour codes are
used elsewhere in the report.
13
Methodological notes (cont’d)
Interpretation of significance testing
The following colour codes are used throughout the report to indicate when results are statistically
different from the average:
Above average
Same as average
Below average
Above-average results are more desirable, while below-average results often indicate areas in need
of improvement.
It must be cautioned, however, that sample sizes in some provinces are much smaller than in others
and have wider margins of error. (The most robust samples are in Quebec, Ontario and Alberta
because there was additional funding from those provinces.) For this reason, 2 provinces may have
the same numeric results in different colours (e.g., 1 result might be blue, or same as average, while
the other is orange, or below average). This may be due to a difference in margins of error rather than
a difference in health system results. The wider the margin of error, the more difficult it is for a result
to show up as significantly different from the average.
14
Access to care
Timely access to care
Cost as a barrier to health care
15
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
16
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).
17
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.
18
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.
19
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.
20
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.
21
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
22
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
23
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%
24
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+.
25
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.
26
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.
27
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
28
Caregiving and planning
for end-of-life care
Informal caregiving
Planning for end of life and advanced age
29
Informal caregiving is common across countries
19%
of older Canadians provided care at least once a week to a person
living with an age-related problem (CMWF average 20%).
Relationship with care receiver
Familymember
member
Family
76%
Someone
Someone
elseelse
(notfamily
familymember)
member)
(not
Both
Both
Proportion providing care
for at least 10 hours a week (2014)
18%
5%
United States
Australia
New Zealand
CANADA
Germany
United Kingdom
CMWF AVERAGE
Netherlands
Switzerland
Norway
France
Sweden
47%*
40%
30
Informal caregivers in Canada don’t always
get the support they need
Proportion of caregivers who needed
help to provide care in the past year
but did not receive it
Reasons for not receiving the help
needed to provide care
Services were
not available
in
Services
were not
the
area
available in the area
23%
28%
Did not know where to go
Cost was too expensive
Waiting
Wait times were too long
27%
16%
14%
31
Distress is common among Canadian caregivers
34%
experienced distress, anger or depression while providing care
or assistance for a family member or friend.
Proportion of caregivers who experienced
distress, anger or depression,
by hours of care provision
43%
Some factors most commonly
associated with caregiver distress:
•
Caring for someone with
aggressive behaviours
•
Caring for someone with cognition
problems (e.g., dementia)
•
Caring for someone for many
hours a week
27%
<10 hours
10 hours or more
Source
Canadian Institute for Health Information. Supporting
Informal Caregivers—The Heart of Home Care.
Ottawa, ON: CIHI; 2010.
32
End-of-life care planning is common in Canada
In 2014, older Canadians were more likely than older people in other countries
to have planned for their end-of-life wishes.
Proportion of older Canadians who
Had discussions with someone
Had a written document naming a
substitute decision-maker
Had a written plan about their
end-of-life wishes
33
End-of-life care plans are more common
with advanced age
39%
of older Canadians had a written plan about their end-of-life wishes.
How does Canada compare (2014)?
Proportions by age
Germany
49%
United States
CANADA
Australia
32%
Switzerland
CMWF AVERAGE
43%
39%*
22%
New Zealand
United Kingdom
Netherlands
Sweden
France
Norway
55–64
65–74
75+
34
How do the provinces compare?
End-of-life care planning in most provinces exceeded the international average.
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Had a discussion
with someone
61% 62% 57% 60% 64% 57% 55% 56% 55% 47% 61%
44%
Named a substitute
decision-maker
46% 53% 44% 50% 60% 52% 47% 43% 42% 32% 53%
31%
Had a written document
about end-of-life wishes
36% 43% 29% 35% 44% 40% 24% 29% 26% 18% 39%
22%
Compared with the CMWF average
Above average
Same as average
Below average
35
About half of Canadians are planning for future
care needs
Proportion who considered
supportive living, residential care
or home care in future planning
47% 48% 46% 45% 48% 47%
42%
Proportion who said they will likely
require supportive living or long-term
care in their lifetime
47%
45%
36%
32%
53%
No significant variation by province
B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can.
Compared with the Canadian average
Above average
Same as average
Below average
36
Advanced directives are common in long-term care
Proportion of Canadian long-term care residents who had
Do not resuscitate order
66%
Do not hospitalize order
18%
Living will
13%
Other end-of-life care restrictions
5%
Feeding restrictions
4%
Medication restrictions
4%
Source
Continuing Care Reporting System, 2011, Canadian Institute for Health Information.
37
Quality of care
Patient-centred primary and specialist care
Medication reviews
Chronic condition management
and disease prevention
38
Most older Canadians have a positive experience
with their regular doctor
When older Canadians needed care or
treatment, their regular doctor always or often
Canada
CMWF average
Knew important information about their
medical history
87%
87%
Spent enough time with them
82%
86%
Encouraged them to ask questions
70%
66%
Compared with the CMWF average
Above average
Same as average
Below average
39
Patient-centred care from specialists
is also relatively good in Canada
When specialists provided care or treatment,
they always or often
Canada
CMWF average
Told patients about treatment choices
72%
72%
Involved patients as much as they wanted
to be in decisions about treatment or care
79%
77%
Compared with the CMWF average
Above average
Same as average
Below average
40
However, continuity of care between regular
doctors and specialists can be improved
In the past 2 years, was there a time when
Canada
CMWF average
A specialist did not have basic information or test
results from the patient’s regular doctor about the
reason for the visit
13%
9%
A patient’s regular doctor did not seem informed
and up to date about the specialist care received
25%
18%
Compared with the CMWF average
Above average
Same as average
Below average
41
How do the provinces compare?
B.C.
Alta.
Sask. Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Regular doctor always or often
Knew important information
about patients’ medical history
88% 86% 89% 84% 86% 89% 87% 85% 87% 84% 87%
87%
Spent enough time
with patients
81% 80% 80% 79% 81% 87% 80% 85% 80% 78% 82%
86%
Encouraged patients to
ask questions
72% 70% 64% 65% 68% 76% 68% 66% 72% 62% 70%
66%
Told patients about
treatment choices
74% 74% 75% 78% 77% 58% 73% 76% 80% 77% 72%
72%
Involved patients as much as
they wanted to be in decisions
81% 79% 83% 76% 80% 76% 81% 85% 88% 79% 79%
77%
Specialists always or often
Compared with the CMWF average
Above average
Same as average
Below average
42
How do the provinces compare?
Continuity of care between primary doctors and specialists was comparable to the
international average in most Canadian provinces.
Specialist did not have basic
medical information from
primary doctor
Primary doctor did not seem
informed or up to date about
care from specialist
B.C.
Alta.
Sask.
8%
8%
8%
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
11% 10% 26% 13%
6%
4%
9%
13%
9%
16% 18% 18% 18% 18% 46% 22% 10% 13% 10% 25%
18%
Compared with the CMWF average
Above average
Same as average
Below average
43
Medication reviews are common for
older Canadians
80%
said a health care professional reviewed their medications in the
past 12 months.
How does Canada compare (2014)?
United States
New Zealand
CANADA
80%*
Germany
In Canada, seniors use an average
of 7.2 prescription drugs in a year.
Australia
United Kingdom
Switzerland
CMWF AVERAGE
70%
Netherlands
Norway
France
Sweden
Source
Canadian Institute for Health Information. Drug Use
Among Seniors on Public Drug Programs in Canada,
2012: Revised October 2014. Ottawa, ON: CIHI; 2014.
44
Canadians are more likely to have discussions
about medication use
In the past 12 months, has a health care professional
Explained potential side effects
CANADA
United Kingdom
New Zealand
United States
Australia
Germany
CMWF AVERAGE
France
Netherlands
Switzerland
Norway
Sweden
Provided a written list of all medications
74%*
59%
Sweden
United Kingdom
CANADA
New Zealand
Netherlands
United States
Australia
CMWF AVERAGE
Germany
Norway
Switzerland
France
67%*
57%
45
Patient safety incidents related to medication
use are common in Canada
Proportion of seniors on public
drug programs taking a potentially
inappropriate (Beers list) drug, 2012
Almost 140,000 hospitalizations
for adverse drug reactions among
seniors between 2006–2007
and 2010–2011
Source
Canadian Institute for Health Information. Adverse Drug
Reaction–Related Hospitalizations Among Seniors, 2006 to 2011.
Ottawa, ON: CIHI; 2013.
39%
Source
Canadian Institute for Health Information. Drug Use Among Seniors
on Public Drug Programs in Canada, 2012: Revised October 2014.
Ottawa, ON: CIHI; 2014.
46
How do the provinces compare?
Across provinces, medication management among older patients was equal to or better
than that in other countries, on average.
In the past 12 months, has a health care professional
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Reviewed all
medications
77% 78% 78% 75% 83% 83% 75% 66% 77% 65% 80%
70%
Explained potential
side effects
72% 72% 72% 67% 76% 76% 67% 70% 68% 62% 74%
59%
Given a written list
of all medications
59% 58% 58% 51% 67% 80% 66% 62% 57% 54% 67%
57%
Compared with the CMWF average
Above average
Same as average
Below average
47
Care to help manage chronic conditions
is above average in Canada
78%
of older Canadians had at least 1 chronic condition*
(CMWF average 71%).
Older people with chronic conditions who
Canada
CMWF average
Had discussions about main goals or priorities
with their health providers
60%
55%
Received clear instructions about symptoms
to watch for
60%
56%
Compared with the CMWF average
Above average
Same as average
Below average
* Chronic conditions include hypertension or high blood pressure; heart disease, including heart attack; diabetes;
asthma or chronic lung disease such as chronic bronchitis, emphysema or chronic obstructive pulmonary disease;
depression, anxiety or other mental health problems; cancer; and joint pain or arthritis.
48
However, there is room to improve
across countries
People with chronic conditions who received
a written plan for self-management from their
health provider
Canada
CMWF average
37%
35%
Compared with the CMWF average
Above average
Same as average
21%
Routinely
Occasionally
58%
Below average
21% of family physicians routinely
gave their patients with chronic
conditions written instructions for
self-management.
Source
The Commonwealth Fund, 2012 Commonwealth
Fund International Survey of Primary Care Doctors.
49
Hospitalizations for chronic conditions are declining
in Canada but vary widely across the country
Ambulatory care sensitive conditions (ACSCs) are chronic conditions that—when treated
effectively in community settings—should not, in most cases, lead to hospitalization.
ACSC hospitalization rates (per 100,000)
Canadian rates
435
417
319
289
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
258
428 419
425
296
267 275
319
289
B.C. Alta. Sask. Man. Ont. Que. N.B. N.S. P.E.I. N.L. Can.
Compared with the Canadian average
Above average
Same as average
Below average
Source
Canadian Institute for Health Information. Your Health System. http://yourhealthsystem.cihi.ca/. Accessed November 27, 2014.
50
How do the provinces compare?
In most provinces, management of chronic conditions was similar to the international
average experience.
In the past 12 months, has a health professional
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Discussed with patients their
main goals or priorities in
caring for this condition
59% 59% 61% 57% 61% 61% 56% 60% 61% 58% 60%
55%
Given patients clear
instructions about symptoms
to watch for and when to seek
further care or treatment
56% 57% 60% 60% 58% 68% 62% 58% 62% 58% 60%
56%
Given patients a written plan
to help them manage their
own care
42% 32% 36% 34% 35% 38% 35% 41% 42% 39% 37%
35%
Compared with the CMWF average
Above average
Same as average
Below average
51
Discussions about healthy life habits are more
frequent in Canada
But they happened less often in 2014 than they used to.
During the past 2 years, has a health professional discussed
61%
57%
50%
54%
51%*
55%*
48%
43%
37%
35%
25%
2010
2014
A healthy diet and healthy eating
2010
2014
Exercise or physical activity
Canada
2010
23%
2014
Things in life that worry patients
or cause stress
CMWF Average
Source
The Commonwealth Fund, 2010 Commonwealth Fund International Health Policy Survey.
52
Canada leads in smoking cessation discussions
78%
of older Canadians who smoked said a health professional talked
to them about the health risks of smoking or using tobacco and
ways to quit.
How does Canada compare (2014)?
CANADA
United States
New Zealand
France
United Kingdom
CMWF AVERAGE
Sweden
Switzerland
Norway
Germany
Netherlands
Australia
78%*
17% of older Canadians smoked,
higher than the CMWF average.
63%
Lung cancer mortality rates were
among the highest in the world for
Canadian women at 46 deaths
per 100,000 population.
Source
OECD Health Statistics 2014.
53
How do the provinces compare?
During the past 2 years, has a health professional discussed
B.C.
Alta. Sask. Man. Ont. Que. N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
A healthy diet and healthy eating
54% 52% 49% 47% 52% 48% 48% 52% 52% 47% 51%
43%
Exercise or physical activity
60% 55% 52% 51% 55% 55% 49% 54% 55% 51% 55%
48%
Things in life that worry patients
or cause stress
27% 23% 25% 24% 26% 20% 22% 32% 22% 24% 25%
23%
Health risks of smoking or using
tobacco and ways to quit
92% 75% 66% 84% 79% 71% 72% 72% 60% 59% 78%
63%
Compared with the CMWF average
Above average
Same as average
Below average
54
Perception of health
and health care
55
Older Canadians feel better about their health
But they were not as optimistic about their health system.
Proportion who rated their health
as excellent or very good
New Zealand
CANADA
Australia
United Kingdom
United States
CMWF AVERAGE
Switzerland
Sweden
Norway
Netherlands
Germany
France
52%*
38%
Proportion who gave the highest
rating to the health system
Switzerland
United Kingdom
Norway
Australia
New Zealand
CMWF AVERAGE
Germany
Sweden
Netherlands
France
CANADA
United States
44%
34%*
56
Life expectancy for seniors in Canada is
about the same as the international average
Life expectancy is a different way of measuring the health of a population.
Proportion who rated their health
as very good or excellent
Canada
CMWF average
52%
Life expectancy at age 65, 2011
Canada
CMWF average
18.8 years
18.6 years
Canada
CMWF average
21.7 years
21.6 years
38%
Compared with the CMWF average
Above average
Same as average
Below average
Source
OECD Health Statistics 2014.
57
Perceptions of health systems are still low
in Canada but have improved slightly
Overall view of the health care system, 2007 and 2014
2007
2014
10%
16%
27%
54%
34%
53%
On the whole, the system works well and only minor changes are necessary to make
it work better.
There are some good things in our health care system, but fundamental changes are
needed to make it work better.
Our health care system has so much wrong with it that we need to completely rebuild it.
58
How do the provinces compare?
Self-reported health status by province
B.C.
Excellent or very good
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
52% 56% 44% 48% 52% 53% 44% 42% 44% 56% 52%
CMWF Avg.
38%
Health system perceptions by province
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
CMWF Avg.
Minor changes
40% 35% 33% 34% 39% 22% 36% 34% 33% 23% 34%
44%
Fundamental changes
51% 51% 52% 49% 48% 63% 51% 53% 53% 52% 53%
42%
6%
10%
Completely rebuilt
9%
10% 10%
9%
12% 11%
9%
8%
21% 10%
Compared with the CMWF average
Above average
Same as average
Below average
59
Appendix
Provincial results compared
to the Canadian average
Statistical testing indicates whether results are
significantly different from the Canadian average.
60
Timely access to primary care
Older Canadians (55+) who
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
Waited for at least 2 days to see
a doctor
50% 55% 57% 54% 50% 58% 54% 55% 53% 53% 53%
Said it was very or somewhat difficult
to get medical care after hours
47% 45% 49% 55% 47% 60% 53% 59% 57% 65% 51%
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%
Waited for at least 2 months to see
their specialist
24% 28% 32% 32% 24% 25% 29% 27% 28% 34% 25%
Compared with the Canadian average
Above average
Same as average
Below average
61
Cost as a barrier to health care
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
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%
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%
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%
17% 12%
9%
15% 16% 14% 19% 18% 11% 16% 15%
Did not see a dentist when needed to
because of the dental costs
Compared with the Canadian average
Above average
Same as average
Below average
62
Quality of care: patient-centred care
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
Regular doctor always or often
Knew important information about
patients’ medical history
88% 86% 89% 84% 86% 89% 87% 85% 87% 84% 87%
Spent enough time with patients
81% 80% 80% 79% 81% 87% 80% 85% 80% 78% 82%
Encouraged patients to ask questions
72% 70% 64% 65% 68% 76% 68% 66% 72% 62% 70%
Specialists always or often
Told patients about treatment choices
74% 74% 75% 78% 77% 58% 73% 76% 80% 77% 72%
Involved patients as much as they
wanted to be in decisions
81% 79% 83% 76% 80% 76% 81% 85% 88% 79% 79%
Compared with the Canadian average
Above average
Same as average
Below average
63
Quality of care: continuity of primary
and specialist care
Specialist did not have basic medical
information from primary doctor
Primary doctor did not seem informed or
up to date about care from specialist
B.C.
Alta.
Sask.
8%
8%
8%
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
11% 10% 26% 13%
6%
4%
9%
13%
16% 18% 18% 18% 18% 46% 22% 10% 13% 10% 25%
Compared with the Canadian average
Above average
Same as average
Below average
64
Quality of care: medication reviews
In the past 12 months, has a health care professional
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
Reviewed all medications
77% 78% 78% 75% 83% 83% 75% 66% 77% 65% 80%
Explained potential side effects
72% 72% 72% 67% 76% 76% 67% 70% 68% 62% 74%
Given a written list of all medications
59% 58% 58% 51% 67% 80% 66% 62% 57% 54% 67%
Compared with the Canadian average
Above average
Same as average
Below average
65
Quality of care: management of chronic conditions
In the past 12 months, has a health professional
B.C.
Alta. Sask. Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
Discussed with patients their main goals
or priorities in caring for this condition
59% 59% 61% 57% 61% 61% 56% 60% 61% 58% 60%
Given patients clear instructions about
symptoms to watch for and when to seek
further care or treatment
56% 57% 60% 60% 58% 68% 62% 58% 62% 58% 60%
Given patients a written plan to help
them manage their own care
42% 32% 36% 34% 35% 38% 35% 41% 42% 39% 37%
Compared with the Canadian average
Above average
Same as average
Below average
66
Quality of care: health promotion
During the past 2 years, has a health professional discussed
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
A healthy diet and healthy eating
54% 52% 49% 47% 52% 48% 48% 52% 52% 47% 51%
Exercise or physical activity
60% 55% 52% 51% 55% 55% 49% 54% 55% 51% 55%
Things in life that worry patients
or cause stress
27% 23% 25% 24% 26% 20% 22% 32% 22% 24% 25%
Health risks of smoking or using
tobacco and ways to quit
92% 75% 66% 84% 79% 71% 72% 72% 60% 59% 78%
Compared with the Canadian average
Above average
Same as average
Below average
67
End-of-life care
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
Had a discussion with someone
61% 62% 57% 60% 64% 57% 55% 56% 55% 47% 61%
Named a substitute decision-maker
46% 53% 44% 50% 60% 52% 47% 43% 42% 32% 53%
Had a written document about
end-of-life wishes
36% 43% 29% 35% 44% 40% 24% 29% 26% 18% 39%
Compared with the Canadian average
Above average
Same as average
Below average
68
Perception of health and health care
Self-reported health status by province
B.C.
Excellent or very good
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
52% 56% 44% 48% 52% 53% 44% 42% 44% 56% 52%
Health system ratings by province
B.C.
Alta.
Sask.
Man.
Ont.
Que.
N.B.
N.S.
P.E.I.
N.L.
Can.
Minor changes
40% 35% 33% 34% 39% 22% 36% 34% 33% 23% 34%
Fundamental changes
51% 51% 52% 49% 48% 63% 51% 53% 53% 52% 53%
Completely rebuilt
6%
9%
10% 10%
9%
12% 11%
9%
8%
21% 10%
Compared with the Canadian average
Above average
Same as average
Below average
69
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72