Health at a Glance
Difficulty accessing health care services in Canada Health at a Glance
Difficulty accessing health care services in Canada

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by Janine Clarke

Release date: December 8, 2016

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• Highlights
• Introduction
• Definitions of the health care services examined in this article
• Most Canadians did not report difficulty accessing health care services
• "Waiting too long" was the most common reason why Canadians reported difficulty accessing health care services
• Several factors are related to difficulty accessing health care services
• Conclusion
• Data source, methods and definitions
• References and notes
• Related material for this article

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Introduction

Easy and timely access to health care services is important for the health of Canadians. Difficulty accessing services could result in: delays seeking and obtaining treatment, underuse or a lack of awareness of preventive health care or services, increased risk of complications if a diagnosis is delayed, increased financial burden on the health care system (e.g., if patients arrive sicker and/or need to stay longer in hospital), and/or decreased compliance with treatment.^{Note 1,Note 2} As such, an important goal of Canada's national health insurance program is to ensure that all Canadians have access to medically necessary services free of cost.^{Note 3,Note 4} However there are other factors, such as wait times, that can affect access to health care services resulting in some Canadians experiencing difficulty getting the care that they need.^{Note 2,Note 5}

This article explores Canadians' (age 15 and older) self-reported experiences regarding access to selected health care services, in the year prior to answering the survey. Data are from the "Access to health care services" module which was asked to respondents in the 10 provinces as part of the Canadian Community Health Survey every 2 years from 2003 to 2013. The module asks specifically about two groups of health care services: specialized services and first-contact services.^{Note 6,Note 7,Note 8} Specialized services include specialist care, non-emergency surgery and selected diagnostic tests. First-contact services include immediate care, routine care and health information. The results presented in this article are based on the population who required health care services in the twelve months prior to answering the survey. The percentage of Canadians who reported one or more perceived difficulties accessing each of these health care services, along with the most commonly reported reasons for their difficulty, will be presented. In addition, we assessed the sociodemographic (e.g., level of education, employment status) and health characteristics (e.g., perceived health) of those respondents who reported difficulty accessing health care services. The characteristics examined in this article were previously found to be associated with difficulty accessing immediate or routine care.^{Note 2}

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Most Canadians did not report difficulty accessing health care services

In 2013, about 80% of Canadians aged 15 and older accessed one or more specialized or first-contact health care service in the year prior to being surveyed. Of those, the majority (71%) did not report any difficulty accessing services.

The remainder of this article, however, will focus on the Canadians who reported difficulty getting the care they needed. The percent of Canadians that reported difficulty accessing various health care services varied depending on the health care service. For example, 16% reported difficulty accessing non-emergency surgery while 23% reported difficulty accessing immediate care (Charts 1 and 2). For most types of health care services, the percentage who reported difficulty accessing care has not changed significantly since 2003. However, in 2013 the percentage who reported difficulty accessing specialist care or selected diagnostic tests was significantly lower compared to 2003 (Chart 1).

"Waiting too long" was the most common reason why Canadians reported difficulty accessing health care services

People who reported difficulty accessing health care services were asked a follow-up question regarding the reason(s) for their difficulty.^{Note 9} Although many different types of difficulties were reported (e.g., language problems, cost, transportation problems) the top 3 difficulties for each health care service were included (Table 1). This was done in order to limit the focus to the most important reasons. Furthermore, some of the difficulties could not be presented due to a small sample size.

Reasons related to "waiting too long" were among the top three reasons for difficulties with accessing each type of health care service (Table 1). More than 50% of those who reported difficulty accessing any specialized services indicated that the problem was with wait times for an appointment. Wait times were also the main difficulty with access to non-emergency surgery, where 60% reported that they waited too long for surgery. The percentage of Canadians who reported waiting too long for non-emergency surgery has remained unchanged over time (data not shown).

Wait times for health care services is an important issue in Canada – in 2004, the First Ministers committed to a 10-year plan to reduce wait times in Canada for a number of services/procedures.^{Note 4} Although the current analysis indicates that a significant percentage of Canadians reported "waiting too long" as a barrier to accessing health care services, other recent reports suggest that wait times for certain procedures have improved in Canada since 2004.^{Note 10} In fact, the majority of Canadians are receiving procedures, such as hip or knee replacement, hip fracture repair, cataract surgery, or radiation therapy, in a "medically acceptable timeframe", which is defined as the amount of time that is appropriate to wait for a procedure based on clinical evidence.^{Note 11} However, what is considered a "medically acceptable timeframe" may not be considered an acceptable wait time from the perspective of the patient. Since the questionnaire did not specifically ask how long respondents had waited, it is not possible to determine if the wait time was outside the medically acceptable timeframe.

"Difficulty getting an appointment" was another reason why many Canadians experienced difficulty accessing both specialized and first-contact health care services (Table 1). This reason was given most frequently (48%) by people who had difficulty accessing routine care from a family doctor or general practitioner. Having difficulty getting an appointment could be related to physician availability in Canada. The number of physicians in Canada is continually increasing and in 2014 the physician-to-population ratio reached its highest ever (224 physicians per 100,000 people).^{Note 12} However, in that same year, about 15% of Canadians reported that they did not have a regular medical doctor.^{Note 13} This discrepancy may be due to the fact that of those 224 physicians per 100,000 people, only 51% are family doctors.^{Note 12}

For those who have a family doctor, difficulty getting appointments could be related to how services are organized or delivered by their healthcare provider. The amount of time a physician spends on direct patient care in an average week has decreased since the late 1990's.^{Note 14} However, in the last decade, efforts have been made to improve access to health care through the availability of group practices and primary health care networks.^{Note 15,Note 16} Although, this model of health care delivery is not yet fully implemented in all provinces.^{Note 15,Note 16}

Several factors are related to difficulty accessing health care services

Multiple logistic regression analysis was used to identify which of selected sociodemographic and health characteristics were associated with difficulty accessing specialized or first-contact health care services. The adjusted odds ratio for each characteristic found to be significantly associated with difficulty accessing health care services is presented in Table 2. It represents the odds of experiencing difficulty accessing health care services by a given characteristic (e.g., female) compared to a reference group (e.g., male), when the other characteristics were considered.

Age, sex, level of education, immigration status, region of residence and perceived health were significantly associated with difficulty accessing specialized services (Table 2). The odds of reporting difficulty were significantly higher compared with the reference group among: those under the age of 65, females, immigrants, those with at least some post-secondary education and those who reported poor or fair perceived health. The odds of reporting difficulty accessing specialized services were also significantly higher for people living in Quebec or the western provinces (the Prairies and British Columbia) compared with Ontario.

The results for first-contact services were similar to those for specialized services, such that age, sex, level of education, region of residence and perceived health were significantly associated with difficulty accessing services (Table 2). However, people without a regular medical doctor and those who identified as Aboriginal (living off-reserve) also had significantly higher odds of reporting difficulty accessing first-contact services. By contrast, those living in British Columbia (as compared with Ontario) and those with either part-time or no employment (as compared with full-time employment) had a significantly lower odds of difficulty accessing first-contact services. These results are consistent with previous research in Canada, however the strength of the association is generally lower (i.e., all odds ratios are less than 2) in the present analysis which suggests that there may have been some improvement over time.^{Note 2,Note 17}

There are many inter-related factors that may affect one's ability to access health care services, including personal factors (e.g., work schedule, family responsibilities) and system factors (e.g., availability of services). Together these have a complex effect on an individual's opinion about their access to health care which is important to consider when interpreting the results of this study. For many of the characteristics examined in this article, the higher odds of difficulty accessing health care may be related to a greater need for health care services. That is, there may be greater opportunity to experience difficulty because of more frequent use of health care services. For example, previous research in Canada and the United States has shown that women access health care services more than men.^{Note 17,Note 18,Note 19} In the present study, women had a higher odds of reporting difficulties accessing care than men. However, we could not assess whether difficulty accessing care was related to the number of times a person accessed services due to limitations of the questionnaire.

By contrast, some of the groups that had higher odds of difficulty accessing care (e.g., those with higher education) were less likely to have reported accessing health care in the year prior to the survey (data not shown). One possible explanation for this could be related to different expectations among different groups. For example, it has been suggested that those who are younger and those who are more educated may have higher expectations or be more critical of their experience.^{Note 20,Note 21,Note 22} As such, younger or more educated individuals may report more difficulty than their older or less educated counterparts.

Factors related to a person's availability is another possible explanation for experiencing difficulty accessing care. For example, those who work part-time or who do not work may experience less difficulty getting appointments because of a more flexible schedule compared with those who work full-time.^{Note 23}

Income was also included in the analysis although the results are not presented in Table 2 because the association with difficulty accessing health care services was not significant. This is consistent with previous research showing that Canada's universal health care coverage does help to reduce income-based inequalities often associated with difficulty accessing health care services.^{Note 2,Note 18,Note 24}

Conclusion

The results of this study show that on average about 29% of Canadians who required health care reported difficulty accessing these services. Wait times and difficulty getting appointments were the most commonly reported reasons for experiencing difficulty.

The results also showed that certain groups had higher odds of reporting difficulty accessing health care services. These included Canadians under the age of 65, females, those with higher levels of education, full-time workers, immigrants and those with poor or fair perceived health. Further research to understand why these groups are having difficulties is warranted.

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