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Monday, January 20, 2014

Looking at health care system performance: Lessons from the Commonwealth Fund survey

Sukirtha Tharmalingam, Senior Policy Analyst, Health Council of Canada 

The Health Council of Canada has been pleased to be a key contributor to the design and funding of the annual Commonwealth Fund’s International Health Policy Survey (CMWF IHP survey) since 2009. Using the data collected in these annual surveys, we released a series of bulletins under the banner, Canadian Health Care Matters that focused on different aspects of public/patient and physician perceptions and experiences with our health care system.
The 2013 survey of the general public includes about 100 questions that address a comprehensive range of issues in our health care system.  The report we released today, Where you live matters: Canadian views on health care quality , lets us compare the performance of provincial health systems with that of 10 other high-income countries.  We also compare results from the 2013 survey to the same questions asked in 2004, 2007 and 2010.  We find that Canadians’ experiences with their health care system vary widely across the country and from our international counterparts. For example, if you are in BC, you may be happier knowing that your province outperforms all other provinces in getting a same-day or next-day appointment when needed – 41% of respondents say they can. However, even BC as the best performer lags far behind the other 10 other countries participating in this survey.  In the top performing country Germany, 76% of people surveyed report they can get a same-day or next-day appointment.  Over the past decade, Canada has shown little change in this aspect of access to care – hovering around the 40% range since 2004.  This and other comparisons we present in the bulletin serve to raise flags for others to probe further into the factors that contribute to the variations and trends we see.

Looking back and moving forward

With an eye to the future, there are a few insights and learnings that I would like to share based on working with the CMWF surveys for the last four years.
1. Canadians have something to say about their health care system performance and it matters! 

The findings we presented through these reports definitely resonated with Canadians.  This was evident to us through the interest they generated from national and local media and news agencies (the Toronto Star) and (the Globe & Mail), report downloads from our website, references to the statistics we presented, and the plethora of patient stories the reports brought forward.
[The cost of chronic illness] [Worrying about my future] [In search of support: the importance of communication in the heath care system]

2. There are recognizable challenges and limitations to a population based survey data

There are methodological challenges we face when analyzing and reporting on results from these surveys.  Achieving perfectly consistent and comparable survey data across the participating countries and even provinces within Canada is virtually impossible. Examples of some things to consider are variations in response rates, individual interpretation of the survey questions, representativeness of the population being surveyed, or one’s ability to recall an experience. However, tremendous efforts were taken to ensure that we developed questions that were unambiguous and could offer important insights on the health care system. We also employed statistical techniques to help us improve the interpretability of the results.

3. There are recognizable benefits to participating in a cross-sectional annual international survey that assesses health system performance from the perspective of those who interact with it. 

Although self-reported measures derived from population surveys can be challenged, we need to be wary that we are not dismissing results because we think they may not be comparable. There are benefits to these survey findings and the comparative lens (international, provincial, over time) they provide us. It allows us to understand what is being achieved in other countries of similar economic size and income and provokes us to think about where there are potential gains to be made in Canada.  For example, which countries have higher performance and what policy directions and strategies do they share with us? What aspects of the health system have improved over time; which have not?

As the Health Council prepares to wind down in March 2014, we are pleased that CIHI and CIHR-IHSPR have agreed to co-lead the Canadian contributions on future Commonwealth Fund surveys. We have enjoyed the opportunity to bring forward the results from this survey in recent years and have been pleased to collaborate with the health agencies in Alberta, Ontario and Quebec to expand sample sizes in their respective provinces. The self-reported experiences of those who are in direct contact with the health care system provide a unique and vital piece of information that can help to improve the delivery of health care. I hope that this important source of information will continue to play a role in supporting decisions by health care providers, managers, and policy makers. 

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