Canadian patients wait longest to see family doctors

Canada ranks last among 11 OECD countries in a new survey in terms of how quickly people can get in to see their regular family physicians, showing "where a person lives does matter," says the Health Council of Canada.

The finding was published in the council's final bulletin, based on data from the 2013 Commonwealth Fund International Health Policy Survey of the General Public.

The council, an independent national agency, has been reporting on health-care renewal since its creation in 2003. 

The report, titled "Where You Live Matters: Canadian views on health care quality," focuses on differences across the provinces, comparisons among the 11 OECD countries that took part in the survey between March and June 2013, and changes in Canada’s performance over the past decade.

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"What we find is that Canada is really not keeping pace with a lot of these other countries," Mark Dobrow, the group's director of analysis and reporting, said in an interview.

"The highest performing province might be looking pretty good in Canada, but be the worst performing if you compared it to all the other countries in the survey."

For example, 50 per cent of respondents in Ontario said that on the whole, the health-care system works pretty well, compared with 23 per cent in Quebec.

The report notes that improvement in reducing wait times has been modest and is often lacking, and concerns Canadians. Only 31 to 46 per cent of Canadians, depending on the province, could get an appointment the same day or the next day, not including emergency department visits.

Since patients who don't have a primary care provider go to the emergency department, the two waits are related, Dobrow said.

Brantford, Ont., resident Richard Kinsella said he had trouble finding a family doctor when he moved to the city east of Hamilton 15 months ago. Kinsella said people in Brantford commonly turn to the emergency department.

"The emergency, I've been twice, and I was there waiting over six hours."

People in the U.S. have quicker access to their family doctors, with 48 per cent of those polled saying they could get a same-day or next-day appointment, ranking second last among the 11 countries. 

Germany was listed as first in how quickly residents saw their doctors, at 76 per cent, followed by New Zealand at 72 per cent.

Many Canadians don't have a regular doctor

Dobrow said the report raises important questions about the wide variations among provinces in areas such as access to after-hours care, emergency department wait times, affordability of care, co-ordination among care providers, and uptake of screening programs.

"Do we have the rights goals for our system? Are we looking at better health, better care, better value for all Canadians?" he said.

In September, the council suggested that provinces pay attention to issues such as leadership, having the right types of policies, and legislation and capacity building. For example, overall resources in primary care could be increased by expanding scopes of practice of some health professionals and improving their interdisciplinary training.

At Toronto's Wellpoint Clinic, the physicians changed to an "open access" system, meaning patients no longer make appointments weeks in advance. Exceptions include people who need to prebook wheelchair transit services or a physical checkup.

"As physicians, we were worried that we would become inundated with patients on a daily basis," said family physician Dr. Nandini Sathi. "In fact, what's happened it's opened up a little bit more time throughout the day for patients who need to be seen."

Previously, a non-urgent patient may have had to wait up to 10 days or sometimes longer if a doctor was on vacation. "Now it really is 48 hours," Sathi said. More urgent care slots are also available.

The other findings in the report include: 

• Between three per cent and 15 per cent of Canadians, depending on the province, do not have a regular doctor or clinic. 
• Accessing medical care after hours without resorting to emergency care is difficult for 62 per cent of Canadians, ranging from 56 per cent in B.C. to 76 per cent in Newfoundland and Labrador. In contrast, the U.K. cut its problem in half over the same time period. 
• 61 per cent of Canadians rate their health as very good or excellent. 
• 36 per cent of Canadians take two or more prescription drugs, among the highest use of prescription drugs of the 11 countries surveyed.  
• 21 per cent of Canadians skipped dental care in the past year due to cost. 
• 37 per cent of Canadians said their regular doctor did not seem informed about care they had received in the emergency department, a finding that has not improved since 2004. 
• 20 per cent of Canadians hospitalized overnight left without written instructions about what they should do and what symptoms to watch for at home. 
• Between 23 per cent and 49 per cent of Canadians age 50 or older have never had a test to screen for bowel or colon cancer. 

"We still use hospital emergency departments for too much of our primary care. And we show largely disappointing performance compared to other high-income countries, some of which have made impressive progress," the report’s authors concluded. 

Commenting on the findings, Health Minister Rona Ambrose's office said, "Our government is delivering the tools the provinces and territories need to deliver health care in their jurisdictions," and reduce health wait times.

The other countries included in the survey are: Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom and United States.