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Public Policy and Canadians’ Attitudes Towards the Healthcare System

Stuart Soroka Stephen SamisIan Brodie

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The Structure of Public Attitudes on Health Care

• Canadians’ attitudes on the current health system seem to be rather divided

• On the one hand, perceptions of past & current levels of care are relatively positive

• On the other hand, perceptions of the future of the system are relatively negative

• These two attitudes are not fundamentally opposed, however; rather, they reflect a quite rational difference between perceived levels of care now and in the future.

• This presentation has three objectives:• to set out the current state of Canadians’ attitudes on the quality

of health care• to make the case for distinguishing between attitudes about current versus future, and personal versus systemic evaluations of care

• to highlight the potential roles of personal experience and media content, in public attitudes towards health care

Introduction

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1. Perceived Current Quality of Health Care

Health Care Policy Mood captures the

trend in attitudes about the current quality of

health care. It is based on an analysis

forthcoming in: Stuart N. Soroka and Adam

Mahon, “Better Value: A Report for the The

Health of Our Nation – The Future of Our

Health System National Expert

Commission, the Canadian Nurses

Association (CNA) and the Canadian Health

Services Research Foundation (CHSRF).

Trends in survey data suggest that Canadians’ perceptions of the quality of care have been improving over the past 5 years.

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2. Distinguishing between Perceptions of Past versus Future, and Personal versus System-level Care

Drawn from Stuart N. Soroka, Antonia

Maioni and Pierre Martin. “What Moves

Public Opinion on Health Care?

Individual Experiences, System

Performance and Media Framing.” Work

in progress.

Personal System-level

Past

We are interested in how you feel about the health care you receive. Thinking

about the last five years, would you say that the health care that you and your family have received has been…very

good, good, fair, poor, very poor

Now we’d like to ask about our health care system in general. Thinking about the last five years, would you say that the health care that Canadians in general receive has been… very good, good, fair, poor,

very poor

Future

And now think about when you and your family might need health care in the future,

meaning a few years from now or more.  Do you expect that the health care you

receive then will be…much better, somewhat better, about the same,

somewhat worse, much worse.

And what about a few years from now or more? Do you expect that the health care Canadians receive in the future will be… much better, somewhat better, about the

same, somewhat worse, much worse.

There are different components of attitudes on health care that are of importance to policymakers. In particular, policymakers need to focus on attitudes about past/current and future care, where the latter are particularly important to ongoing public support for the health care system.

A. Survey Questions

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2. Distinguishing between Perceptions of Past versus Future, and Personal versus System-level Care

Data from the IRG Canada 20/20 online

panel; analysis drawn from Stuart N. Soroka,

Antonia Maioni and Pierre Martin. “What

Moves Public Opinion on Health Care?

Individual Experiences, System

Performance and Media Framing.” Work

in progress.

B. Survey Responses, April 2012

Recent results suggest that while estimates of current levels of care are relatively positive, there are real concerns about the future of the system.

% respondents 6

2. Distinguishing between Perceptions of Past versus Future, and Personal versus System-level CareC. Trends over Time

And even as perceptions of current care are increasing, trends show declining perceptions of future care.

Data from Ipsos Health Report Cards: “What mark/letter grade would you give to... The overall quality of the healthcare services available to you and your family?” [% respondents giving A or B grades minus % respondents giving C or F grades.

Data from Ipsos Health Report Cards: “Overall, do you think health care services in your community will get much better, somewhat better, somewhat worse or much worse over the next two or three years?” [% respondents giving A or B grades minus % respondents giving C or F grades.

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3. Where do Canadians’ attitudes on health care come from?

Canadians perceptions of the health care system are partly a product of their own experience with that system.

Estimated effect of wait times on confidence in the

health care system.Data: 2007 IHP Survey.

Estimated effects including controls for gender, age,

education, income, and self-reported health.

Analysis from Stuart N. Soroka and Patrick Fournier, “

The Sources of Attitudes on the Canadian Healthcare System: A Report to the Canadian Health Services Research Foundation

,” September 2011.

Doctor(waiting more than

one day)

Emergency(waiting more than

one hour)

Elective Surgery(waiting more than

one month)

A. Experience

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Trends in media coverage and public perceptions of

“crisis”

Media Coverage (gray): # stories dealing with wait lists,

Globe and Mail and Toronto Star.

Public Opinion (blue): % saying “crisis” - % saying “good shape”

from “Which of the following is closer to your point of view ...

Canada’s health care system is basically in good shape ...

Canada’s health care system is in a state of crisis?”

Analysis from Stuart N. Soroka

and Patrick Fournier, “The Sources of Attitudes on the Canadian Healthcare System: A Report to the Canadian Health Services Research Foundation

,” September 2011.

3. Where do Canadians’ attitudes on health care come from?

B. Media Coverage

Canadians perceptions of the health care system are also driven by media content

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The Structure of Public Attitudes on Health Care

• In sum, Canadians are relatively pleased with current levels of care, but deeply concerned about the future of the system.

• One result is a weakening of support for the current system, and increasing consideration of other options.

• There is a real pressure on policymakers to deal with the current state of the healthcare system, then.

• Canadians attitudes are affected by their interactions with the system; so positive changes in the system can lead to shifts in public support.

• But other factors matter to Canadians’ attitudes on health care as well -- including media content.

Conclusions

(On many of these issues, see work in The Sources of Attitudes on the Canadian Healthcare System and

Public Perceptions and Media Coverage of the healthcare System: A Synthesis Canadian)

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Public opinion and health policy

• Rich data environment – plenty of opinion evidence

• Often top of mind, but …• Experience-driven perceptions – Rooted

opinion• Depressed expectations• Trust deficit

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Trust deficit

• “Hidden agendas”• Reduced access• Policy vacuum

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Top of mind issue

• Frequently the top of mind issue• But not usually by large margin• Is ‘health care’ an invented opinion?

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Experience-driven perceptions

• Access to family practitioner drives perceptions

• Which isn’t surprising given the size of wait lists

• But, expectations of improvement/change

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Wait times guarantees

• Federal promise • Alberta promise

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