Canadians spend more than $100 billion a year on their healthcare system. The Canadian Institute for Health Information reports that healthcare spending in 2001 equaled $3,298 per person. With the introduction of a public insurance plan for hospital services in 1947, the province of Saskatchewan started the ball rolling on what would become the Medical Care Act, or "Medicare," ensuring universal public health coverage for all 10 provinces and 2 territories. In introducing the Canada Health Act in 1984, the federal government discouraged provincial user charges and extra billing by providing for a mandatory, dollar-for-dollar penalty to be deducted from federal transfer payments (payments from the federal government to the provincial government for the province's healthcare system). How do Canadians currently perceive this universal healthcare system -- as a source of pride or of problems?
Healthcare as Most Important Problem
According to a January Gallup Poll, healthcare takes the spotlight as the most important problem facing Canada, currently regarded as so by 25% of the Canadian public. Concern for healthcare has been foremost in Canadians' minds since November 2000, when almost half (46%)* of Canadians put it at the top of their list of problems facing the country. While Canadians have enjoyed universal government-funded healthcare for several generations, it appears they feel the current system does not sufficiently meet their needs.
Canadians pride themselves on a healthcare system that makes care available to all citizens, often contrasting this to the system in the United States. Yet when this same question ("What do you think is the most important problem facing this country today?") was recently asked in the United States, only 5%** of Americans named healthcare, putting it far behind the economy and concern about international matters.
Satisfaction With Quality and Availability of Healthcare
Although Canadians view healthcare as a major problem facing their country, they are also somewhat divided when asked specific questions about the healthcare system. The January poll shows that less than half of Canadians (45%) feel the Canadian healthcare system in general is "very" or "somewhat" satisfactory, while a majority (57%) are "very" or "somewhat" satisfied with "the availability of affordable healthcare" in Canada.
As Canadians pride themselves on a system that provides healthcare equally to all residents, it is encouraging that a majority feels that availability is satisfactory. Yet the news is not all good. Nearly the same percentage of Canadians are very dissatisfied with the availability of affordable healthcare (17%) as are very satisfied with it (16%).
Canadians are also divided in their opinions regarding the "quality of medical care" in Canada. Fifty-two percent are either very or somewhat satisfied with Canada's quality of medical care, while a similar number (48%) are very or somewhat dissatisfied with it. Across the board, older Canadians are more likely than younger Canadians to be very dissatisfied with Canadian healthcare. They may be more likely to access healthcare services than their younger counterparts, and therefore more likely to experience long waits or shortages of healthcare practitioners.
Bottom Line
Canadians continue to enjoy among the highest per-capita spending on healthcare in the world. Accustomed to universal healthcare services covered by their provincial and federal governments, they are critical of any changes that may result in less than universal, accessible coverage for all residents. Gallup data indicate that Canadians are divided on the issue of introducing a "two-tiered" healthcare system that would give them the option to pay for any additional services they wanted. (See "The Haves and Have Nots of Healthcare" in Related Items.) Over the next several years it will be interesting to see if Canadian dissatisfaction with the healthcare system will lead to some form of privatization, as has already been discussed in some provinces.
*Results in Canada are based telephone interviews with 1,008 national adults, aged 18 and older, conducted Jan. 29-Feb. 7, 2003. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±3%. The survey was conducted by Gallup Canada.
**Results in the United States are based on telephone interviews with 1,000 national adults, aged 18 and older, conducted Jan. 13-16, 2003, and 1,001 national adults, aged 18 and older, conducted Feb. 3-6, 2003. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±3%.