1. Thank you for joining us today for CHSRF on Call! Please turn on your computer speakers to connect to the audio for this session. (If you do not have computer speakers you can dial 1.866.250.5144 to connect via telephone) If you need assistance at any time please choose a tech support option below. 1

2. Public Policy and Canadians’ Attitudes Towards the Healthcare System Stuart SorokaStephen SamisIan Brodie 2

3. 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 3

4. 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. 4

5. 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. PersonalSystem-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 5

6. 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

7. 2. Distinguishing between Perceptions of Past versus Future, and Personal versus System-level Care C. 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. 7

8. 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.The Sources of Attitudes on the Canadian Healthcare System: A Report to the Canadian Health Services Research Foundation Doctor (waiting more than one day) Emergency (waiting more than one hour) Elective Surgery (waiting more than one month) A. Experience 8

9. 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.The Sources of Attitudes on the Canadian Healthcare System: A Report to the Canadian Health Services Research Foundation 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 9

10. 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)The Sources of Attitudes on the Canadian Healthcare SystemPublic Perceptions and Media Coverage of the healthcare System: A Synthesis Canadian) 10

11. 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 11

12. Trust deficit “Hidden agendas” Reduced access Policy vacuum 12

13. Top of mind issue Frequently the top of mind issue But not usually by large margin Is ‘health care’ an invented opinion? 13

14. Experience-driven perceptions Access to family practitioner drives perceptions Which isn’t surprising given the size of wait lists But, expectations of improvement/change 14

15. Wait times guarantees Federal promise Alberta promise 15

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