No. 36: Canadians’ Views about Health System Performance

Duckett, S. and Kempton, A. Canadians’ Views about Health System Performance

Healthcare Policy, 7 (3) 2012: 85-101


The planned renewal in 2014 of Canada’s Health Accord would have provided Canadians an opportunity to review the fundamentals of their health care system. One of the strengths of the 2004 Health Accord was that it united all governments in Canada — provincial, territorial, and federal — around objectives aimed at improving Medicare. However, this review became more challenging after the federal government indicated in December 2011 that it would not participate, thereby abandoning its leadership role as an essential partner in shaping Medicare’s future. This is in sharp contract to other countries, such as the US, where the federal government recently played a major leadership role in the passage of Obamacare.

So eight years after the 2004 Health Accord, how do Canadians feel about our health care system? This study examines Canadians’ priorities, and assesses how satisfied we are with our health care compared to those in Australia, the United Kingdom, and the United States. 

Methods and Limitations

This study used the 1998-2010 published results from 13 Commonwealth Fund international health surveys to assess Canadians' views of health system performance and compared these to the views of respondents from Australia, the United Kingdom, and the United States. Four of the surveys represent the views of health care providers, and the rest represent the experiences and views of health care consumers.


Every year, the Commonwealth Fund asks whether, in the opinion of the respondents, their health care system requires minor change, fundamental change, or a complete rebuild. Although the organization of health care among the four countries varies from state-run in the United Kingdom to market-dominated in the United States, dissatisfaction is the norm in all. The surveys show that, “Canadians are less inclined to think that the health system has so much wrong with it that it needs a complete rebuild compared to Australians and residents of the United States.” In fact, ordinary Canadians are now less likely to think that their health care system needs a complete rebuild than in the first year of the survey, declining from 23 per cent in 1998 to 10 percent in 2010. By comparison, in 2010 more people in the United States and Australia called for a complete rebuild, at 27 and 20 percent respectively.

Timely access to care and affordability are other significant elements surveyed. Whereas the United States fares well on access, as measured by wait times, but poorly as measured by affordability, Canada tends toward the reverse. Canadians are less likely than Americans or Australians to go without a doctor visit or prescription medication because of cost, and the British are least likely. Canadians reported the most difficulty in obtaining same-day primary care appointments, timely emergency care, elective surgery, and specialist consultations.

Views among surveyed health care providers were similar to those of the consumer groups. Compared with colleagues in the other countries, Canadian physicians reported the lowest concern about affordability of care, but the greatest concern about waiting times.


Almost all citizens of the surveyed countries find fault with their health care systems. Canadians continue to be frustrated with waiting for specialized diagnostic and treatment procedures, but face relatively few financial barriers for medical care. The more market-oriented systems in Australia and the United States offer quicker access to specialized interventions, but only for those who can surmount the financial barriers, and neither consumers nor providers are any more content with their health care system. Despite a very low percentage of Canadians currently experiencing barriers to care due to cost, the surveys still indicate that a much higher percentage of Canadians are worried about being able to afford care for themselves or their families in the future. This could potentially reflect concern about the services not covered by Medicare, such as dental care, optometry, and prescription medications, in addition to the overall desire to improve our health care system. The media also play a significant role in shaping public debate and opinion, and this e-round reinforces the importance of evidence-based contextualized reporting to communicate Medicare’s relative successes and challenges.


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