Almost two-thirds of Canadians unprepared to finance their future health care costs; more than half open to private health care

Toronto, November 24, 2009 — Canadians increasingly want to be treated as consumers rather than as patients. They want improved service, personalized programs, greater access to their health records, and more education and options for health self-management. They also want to work collaboratively with industry stakeholders to achieve these goals while keeping costs in check and using existing resources, according to new research by Deloitte.

“This transition from a patient-orientation to a consumer-orientation will have far-reaching implications for all industry stakeholders and will place new demands on the health system and raise new challenges,” says Mark Fam, Senior Manager, Deloitte National Health Services and lead author for the Canadian health consumer survey. “Yet it also presents health care industry stakeholders with new opportunities to experiment, to innovate and to adapt to help Canadians improve both their health and wellness.”
“It’s not that Canada’s health care system lacks many exceptional features, it’s that Canadians’ needs continue to evolve and the system is not keeping pace with their expectations,” explains Lisa Purdy, Partner, National Health Leader, Deloitte.

These findings are the result of Deloitte’s 2009 Canadian health care consumer survey report which surveyed 2,304 Canadian adults in an effort to better understand the perspectives of Canadians as health care consumers. Consumers from all 10 provinces were surveyed. The study identifies implications for health providers and policymakers as they face the growth of health consumerism through a comprehensive assessment of consumers’ behaviours, motivations, attitudes and unmet needs related to health and healthcare. While most Canadians form these beliefs based on personal experiences rather than through a studied view of the system, this survey did examine their experiences across the health care system, including interactions and experiences with physicians, hospitals, prescription medications, insurance companies, and government.

To capture the full breadth of consumer needs, the survey focused on six major areas of health care consumer activity — health policy, health insurance, traditional health services, information resources, alternative health services, and wellness and health management — and uncovered several key findings:

• Canadians feel unprepared to handle future health care costs. Although three-quarters (75%) of Canadians report having private health insurance (primarily through their employer,) only one-quarter (25%) feel well insured across their public and private insurance plans and only 39% feel they are well prepared to handle future health care costs.
• A majority of Canadians support expanding private care, as long as there is no impact on the public system and a reduction in wait times. More than half (56%) of respondents indicate they support increasing private care services if there is no impact on the current publicly funded health care system, while half (50%) of Canadians support increasing private care services if it resulted in an overall reduction in wait times for public care.
• Improving responses to pandemics is among Canadians’ top health reform priorities. Canadians’ top priorities regarding government allocation of health care funds are as follows: 85% favour expanding physician teaching programs, 68% favour increasing funding to support expanding community care services, 61% favour improving public health surveillance and outbreak/pandemic response, and 59% favour governments continuing to implement electronic health records. Furthermore, Canadians’ support of politicians hinges on their commitment to increasing access to services, physicians and medications (69%), improving the quality of care (68%), and reducing health costs (51%).
• Canadians are less satisfied with hospital care than Americans. Canadians are less satisfied with their recent hospital care experiences than Americans (62% of Canadians vs. 74% of Americans were satisfied). In addition, the most important factors in choosing a hospital used recently for Canadians was that it was close to home and for Americans it was insurance coverage.
• Canadians want to own more of their health information. Almost two-thirds (61%) of Canadians want their physicians, hospitals and/or the government to provide them with a personal health record (PHR) or online medical records, and two-thirds (66%) would like to access a family member’s PHR.
• Caregiving financially impacting a significant amount of Canadians and is on the rise. More than a quarter (28%) of Canadians provide health care assistance to a family member, friend or other, and 38% of these caregivers have been providing constant care for more than two years (which is expected to increase as the population ages). Of these, one in five (20%) family caregivers report a reduced ability to earn income.
• Canadians are expanding their criteria for physician selection. One in four (25%) respondents said they prefer a physician affiliated with a hospital, 25% preferring a physician who works in an inter-professional team, and 25% saying they prefer physicians who act as health coaches by providing guidance to help them make their own decisions. However, one-third (33%) of Canadians still prefer physicians who act as medical authorities and use their own expertise to recommend the best health care approach.
• Increasing demand for online tools and services. More than half (51%) of Canadians are interested in gaining access to a secure Internet site that allows them to schedule office visits, access medical records, view test results, order prescription refills, find information about treatment options, and check the status of bills and payments. Similarly, about half (49%) of respondents want to be able to contact their physician via email to exchange information about their health and get answers to questions, and 40% are interested in a nurse call line where they can seek advice about a health problem or help with decisions about when to go the emergency room or doctor's office.

Regional differences emerge in Quebec, Saskatchewan, and B.C.
Canadians across the country are aligned on most issues presented in the survey. However, a few key differences emerged on some points. On the issue of private health care, more Quebec consumers (19%) have used private health services in the past 12 months than the Canadian average (6%). In the traditional health sphere, fewer Saskatchewan residents (28%) than Canadians on average (42%) believe quality varies widely across hospitals. Regarding the integration of alternative health services, 20% of British Columbians prefer physicians who integrate holistic approaches into their practice, compared to the Canadian average of 14%.

Delivering on consumer demands will require private care, policy reform and new services
The findings and conclusions from this survey suggest that the expectations of health care consumers will intensify in the coming years, resulting in several key implications for health system stakeholders across government, hospitals, physicians and other health providers. Delivering on this notion of ‘patient-centred care’ requires stakeholders to offer more personalized options, which will drive a parallel need for stakeholders to converge their strategies by:

• Proceeding cautiously with private care options. Consumers are willing to entertain increased costs for specialized services or enhanced private care if the public health system is maintained. This means that health reform efforts to expand private care options can proceed, but not in an ‘either/or’ manner. Efforts must ensure the integrity of the public health system.
• Focusing on initiatives that increase access to physicians and community services. National and provincial policy reform that prioritizes physician and community service access will achieve the greatest return on consumer value.
• Implementing online tools, personal health records, and consumer access to their physicians. Stakeholders need to supplement trusted provider-patient relationships with improve access to customizable Internet tools and continue to push forward on an e-health agenda that enables personalized health services in a sustainable cost model.
• Sharpening their skills in targeting consumers on quality, safety, and convenience. This is key as consumers are increasingly differentiating based on quality, service, satisfaction, and the value proposition for their unique circumstance, and as public reporting increases, and private or offshore services are being explored.

Fundamental changes to Canada’s health care system are emerging
Health consumerism is not a fad, it is a trend. It continues to grow and, in doing so, it is emerging as an important market driver that will fundamentally change the health care system in Canada. While industry stakeholders are only beginning to grasp the demands that consumerism will place on the system, new challenges and opportunities are already arising. Only through an across-the-board change will the potential benefits be realized. Fortunately, this type of change is well within the skill set of Canada’s health system providers – promising opportunities for transformation that can only help to improve both personal and systemic health.

About the survey
The 2009 Canadian health care consumer survey report is based on a national survey of 2,304 Canadian adults (aged 18 and older) conducted in November 2008. It is the most recent and comprehensive survey of its kind. Respondents completed a questionnaire that consisted of 74 questions, with 46 potential follow-up questions. Consumers from all 10 provinces were surveyed, however the territories were not included. This survey was conducted by the Deloitte Center for Health Solutions as part of a global series on health consumerism, which surveyed consumers across the United States, United Kingdom, France, Germany and Switzerland. To download a copy of this survey, please visit www.deloitte.com/ca/patientsasconsumers

About the Deloitte Center for Health Solutions
The Deloitte Center for Health Solutions (the “Center”) was formed to further research and develop solutions to some of the most important health care issues facing governments and health care providers around the world. The Center is also devoted to finding common-ground solutions to shared problems in health care. With its partners and stakeholders, the Center is developing innovative ideas and programs to make health care more efficient, affordable and accessible. For further information, please visit www.deloitte.com/centerforhealthsolutions.

About Deloitte
Deloitte, one of Canada's leading professional services firms, provides audit, tax, consulting, and financial advisory services through more than 7,700 people in 57 offices. Deloitte operates in Québec as Samson Bélair/Deloitte & Touche s.e.n.c.r.l. Deloitte & Touche LLP, an Ontario Limited Liability Partnership, is the Canadian member firm of Deloitte Touche Tohmatsu. Deloitte refers to one or more of Deloitte Touche Tohmatsu, a Swiss Verein, and its network of member firms, each of which is a legally separate and independent entity. Please see www.deloitte.com/about for a detailed description of the legal structure of Deloitte Touche Tohmatsu and its member firms.

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