Ambulances are parked in the ambulance bay at Windsor Regional Hospital - Ouellette Campus in December, 2023. In Ontario, the Progressive Conservative government is outsourcing more publicly funded endoscopies, MRI scans, CT scans, and cataract surgeries to private clinics.Dax Melmer/The Globe and Mail
Nearly half of all Canadians say their access to medical care has worsened over the last few years, with two-thirds experiencing what they consider an unreasonable wait for surgeries and other services, a new survey has found.
As a result, 73 per cent now say they’re open to major reform of the health care system, including a larger role for the private sector. But that doesn’t mean they support private payment: Nearly two-thirds felt it wouldn’t be fair to allow patients to buy medically necessary care because, “the rich would be better served.”
The survey results from the research arm of the public-relations firm Navigator are the latest to highlight the long-standing tension between Canadians’ desire for a transformed public-health system and their discomfort with allowing people to pay their way to the front of the queue.
The Canadian Medical Association, which speaks for the country’s physicians, received similar feedback on out-of-pocket payments when it consulted more than 10,000 people through surveys, town halls and focus groups for a draft policy on private and public care published in July. A key takeaway was that Canadians – including doctors – believed medical care should be distributed on the basis of need, not ability to pay, then-CMA president Kathleen Ross said at the time.
Jaime Watt, the executive chairman of Navigator, said his firm conducted the survey in hopes of learning what Canadians wanted as consumers of medical care rather than as taxpayers or citizens. In addition to polling services, Navigator Ltd. engages in public relations, crisis management and government relations, and has lobbied on behalf of health care organizations.
“They want more flexibility, and they want more choice in the system,” Mr. Watt said. “This old adage that health care reform is the third rail of Canadian politics and therefore politicians shouldn’t touch it is not true. They want them to touch it, and they want to bring reform.”
Despite 73 per cent telling Navigator that Canada’s health system needs major reform – up 14 points since 2022 – more people still said they were satisfied with the current health system than not. Fifty-three per cent said they were somewhat or very satisfied, while 29 per cent said they were somewhat or very dissatisfied. The rest were neutral.
Respondents to Navigator’s survey signalled more openness than in the past to health services delivered by private companies and by professionals other than doctors, including pharmacists and nurse practitioners. Sixty-nine per cent agreed some health care services should be provided by the private sector, up five points since the last time Navigator asked the question in 2022.
However, the private sector already plays a significant role in delivering medical services in Canada’s publicly funded, single-payer system. Most doctors are small-business owners. In some provinces, standalone for-profit clinics provide diagnostic services such as lab tests, ultrasounds and colonoscopies, with the tab paid by provincial governments. When the care is deemed medically necessary, patients don’t pay out of pocket, regardless of whether the service is delivered at a private clinic or a public hospital.
In Ontario, the Progressive Conservative government is outsourcing more publicly funded endoscopies, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, and cataract surgeries to private clinics. Premier Doug Ford has promised to do the same to reduce wait times for hip and knee replacements, despite critics arguing the move could siphon staff from public operating rooms and pave the way for two-tier medicine.
The Navigator survey found strong support for turning to the private or non-governmental sectors to tackle surgical backlogs, but 80 per cent said their support was contingent on those operations continuing to be fully publicly funded.
As well, 68 per cent of people said Canadians should be allowed to buy extended health insurance for medically necessary care, something that is effectively banned outside of Quebec. However, only 37 per cent said they were likely to purchase it themselves. (Private insurance is already permitted for care that falls outside the rules of the Canada Health Act, such as dental care, vision care and prescription drugs.)
The survey also asked if Canadians were willing to pay out-of-pocket for different kinds of medical care if that meant they wouldn’t have to wait. In every example but cosmetic surgery (which is not publicly funded to begin with) more than half of respondents said they would not pay.
Still, Susan Innes, Navigator’s lead researcher on the study, said she was surprised at the share of people who were open to the idea. “The thing that jumped out at us was people’s willingness to pay for things that were much more critical, like emergency room care,” she said. Thirty-six per cent said they were willing to pay to avoid waiting in the ER, while 40 per cent said the same for MRI scans, and 44 per cent for cancer screening.
That willingness could reflect a Canadian public frustrated at its lack of access to basic services such as primary care, said Tara Kiran, a family doctor and primary-care researcher at the University of Toronto. She led a project called Our Care that surveyed more than 9,200 Canadians, 22 per cent of whom said they didn’t have a regular family doctor or nurse practitioner.
“It’s pretty clear from the [Navigator] survey that people are dissatisfied with their access to care, and that really aligns with what we heard from people directly,” Dr. Kiran said.
However, her survey also found that 78 per cent of people weren’t willing to pay for the private virtual care services that have proliferated since the start of the pandemic if such companies charged for care that would be free in a doctor’s office. “Our survey results reflected an unwillingness to pay for services that should be public,” Dr. Kiran said, “but also a skepticism of delivery of health care services by for-profit entities.”
The Navigator survey of 1,500 adults was conducted online in early June. A random survey of that sample size would have a margin of error of plus or minus 2.5 percentage points, 19 times out of 20.
Editor’s note: This article has been updated to include information on Navigator’s business activities, which have included lobbying on behalf of health care organizations.