International survey shows Canada lags behind peer countries in access to primary health care
Back to Commonwealth Fund survey, 2023
March 21, 2024 — Primary care providers are often the first point of contact for patients seeking medical care and play a crucial role in the health of Canadians. Results from the 2023 Commonwealth Fund (CMWF) survey of adults in 10 high-income countries reveal the growing challenges that Canadians face in accessing primary health care. They also highlight opportunities for expanding the use of digital tools for communication and information exchange between patients and providers, including virtual care.
Recognizing the importance of high-quality primary health care to the health of Canadians, governments across Canada are working together to improve timely access and efficiency.
Fewer Canadian adults report having a regular doctor or place of care
The proportion of Canadians age 18 and older reporting access to a primary care provider has declined, from 93% in 2016 to 86% in 2023 — the lowest proportion among the 10 countries surveyed (2023 CMWF average: 93%). This means that an estimated 4 million Canadian adults did not have a primary care provider in 2023.
Access to a primary care provider over the years
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The proportions of adults who reported having a doctor or place they usually go to for medical care are as follows for 2023: the Netherlands, 99%; New Zealand, 97%; the United Kingdom, 97%; Germany, 96%; Australia, 94%; CMWF average, 93%; Switzerland, 92%; France, 91%; Sweden, 88%; the United States, 87%; and Canada 86%. For Canada, the proportion who reported having a doctor or place they usually go to for medical care was 90% in 2020 and 93% in 2016. The CMWF average was 94% and 95% in 2020 and 2016, respectively.
Notes
Canada’s 2023 result is significantly lower than the CMWF average.
Canada’s 2023 result is significantly different from its 2016 and 2020 results.
A higher percentage is more desirable.
Sources
International Health Policy Survey of the General Population, 2016, 2020 and 2023, The Commonwealth Fund.
Lack of access to a primary care provider has been shown to negatively impact the health of individuals and of the population as a whole.Reference1 Not having a primary care provider was more common among Canadians with lower levels of household income, younger adults (age 18 to 34) and males.
Of Canadians without a regular primary care provider, 39% reported having at least 1 chronic condition, and 29% took 1 or more prescription medications. Better access to primary health care can lead to better health outcomes, and to fewer emergency department (ED) visits and hospitalizations.Reference2
Socio-demographic characteristics of Canadians with a regular primary care provider
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The proportions of Canadian adults who reported having a doctor or place they usually go to for care by income group are as follows: $150,000 or more, 93%; $125,000 to less than $150,000, 90%; $90,000 to less than $125,000, 89%; $60,000 to less than $90,000, 87%; $30,000 to less than $60,000, 83%; and less than $30,000, 81%.
The proportions of adults who reported having a doctor or place they usually go to for care by age group are as follows: age 65 and older, 93%; age 35 to 64, 88%; and age 18 to 34, 78%.
The proportions of adults who reported having a doctor or place they usually go to for care by gender are as follows: female, 90%; and male, 82%.
Notes
Excludes respondents who did not disclose their income and/or age.
Excludes respondents who selected trans man, trans woman, gender non-conforming or a different gender due to insufficient counts.
Source
International Health Policy Survey of the General Population, 2023, The Commonwealth Fund.
Canadians have more difficulty getting same- or next-day appointments and after-hours care
In 2023, only 26% of Canadians were able to get a same- or next-day appointment (CMWF average: 42%) — a drop from 46% in 2016 — making them least likely among those surveyed to get such an appointment. Less than a quarter of Canadians found it easy to get care in the evenings, on weekends and on holidays without going to the ED (Canada: 23%; CMWF average: 32%).
Same- or next-day appointment to see a doctor or nurse
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For 2023, the proportions of adults who reported that they were able to get a same- or next-day appointment to see a doctor or nurse the last time they were sick or needed medical attention are as follows: the Netherlands, 54%; Germany, 51%; the United Kingdom, 47%; Switzerland, 45%; the United States, 43%; Australia, 42%; CMWF average, 42%; Sweden, 37%; France, 36%; New Zealand, 35%; and Canada, 26%. For 2016, Canada’s result was 46% and the CMWF average was 60%.
Notes
Canada’s 2023 result is significantly lower than the CMWF average.
Canada’s 2023 result is significantly different from its 2016 result.
A higher percentage is more desirable.
For 2023, same- or next-day appointments can include in-person appointments and appointments over the telephone or through video.
Excludes respondents who did not need to make an appointment to see a doctor or nurse, who were never able to make an appointment or who visited a hospital emergency department, urgent care clinic or facility instead of making an appointment.
Sources
International Health Policy Survey of the General Population, 2016 and 2023, The Commonwealth Fund.
Evening, weekend and holiday appointments
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For 2023, the proportions of adults who reported that it was very or somewhat easy to get medical care in the evenings, on weekends or on holidays without going to the emergency department are as follows: the Netherlands, 56%; the United States, 38%; Germany, 37%; Australia, 35%; France, 33%; CMWF average, 32%; New Zealand, 31%; Switzerland, 29%; Canada, 23%; the United Kingdom, 21%; and Sweden, 18%. For 2016, Canada’s result was 35% and the CMWF average was 46%.
Notes
Canada’s 2023 result is significantly lower than the CMWF average.
Canada’s 2023 result is significantly different from its 2016 result.
A higher percentage is more desirable.
Excludes respondents who never needed care in the evenings, on weekends or on holidays.
Sources
International Health Policy Survey of the General Population, 2016 and 2023, The Commonwealth Fund.
Avoidable ED visits are considered an indicator of the adequacy of primary health care.Reference3 Of Canadians who have a primary care provider and visited the ED, 2 in 5 reported that their last ED visit could have been managed at their usual place of care. 75% of Canadians who reported that their ED visit could have been managed elsewhere also reported not being able to get a same- or next-day appointment the last time they were sick or needed to see a doctor.
Most Canadians are positive about the care provided by their primary care provider
While access to a regular doctor can be challenging, Canadians who did have access to a primary care provider generally reported positive experiences with them. Most Canadians reported that their primary care provider was respectful and easy to understand, and involved them in care decisions.
Canadians’ experiences with their primary care providers
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- 86% of Canadian adults reported that their regular doctor or medical staff always treats them with courtesy and respect. The CMWF average is 80%.
- 68% of Canadian adults reported that their regular doctor or medical staff always explains things in a way that is easy to understand. The CMWF average is 62%.
- 58% of Canadian adults reported that their regular doctor or medical staff always involves them in decisions about care and treatment. The CMWF average is 54%.
- 56% of Canadian adults reported that their regular doctor or medical staff always knows important information about their medical history. The CMWF average is 52%.
- 54% of Canadian adults reported that their regular doctor or medical staff always helps coordinate or arrange the care receive from other doctors or places. The CMWF average is 45%. Excludes those who did not need to see any other doctors/health professionals or did not need any coordination.
- 52% of Canadian adults reported that their regular doctor or medical staff always spends enough time with them. The CMWF average is 48%.
Notes
* Excludes respondents who did not need to see any other doctors/health professionals or did not need any coordination.
Excludes respondents who did not have a regular doctor or place they usually go to for medical care.
Canada’s 2023 results are significantly higher than the CMWF average.
A higher percentage is more desirable.
Source
International Health Policy Survey of the General Population, 2023, The Commonwealth Fund.
During the COVID-19 pandemic, virtual care expanded rapidly across Canada, with health professionals offering care remotely via telephone or video.Reference4 A third of Canadians (33%; CMWF average: 23%) said that they accessed virtual care with their primary care provider; females and individuals with higher education levels were more likely to use virtual care. Of those who used virtual care with their primary care provider, most (80%) reported being somewhat or very satisfied with their experience (CMWF average: 78%).
Use of digital health tools is increasing in Canada, but adoption remains low compared with peer countries
While adoption of virtual care has been rising in Canada, the use of digital tools for communication and information exchange with providers was still below the CMWF average.
Primary care physicians are offering more services online, including email, appointment requests and prescription renewals.Reference5 However, Canadians’ use of these online services was generally much lower than the CMWF average.
Use and uptake of digital health and electronic communication tools
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- 21% of Canadians used a secure website or patient portal or an app on their mobile phone to request an appointment with their regular practice. A CMWF average could not be calculated. 38% of Canadian primary care physicians’ practices offered patients the option to schedule appointments online (not including email). The CMWF average is 57%.
- 16% of Canadians used a secure website or patient portal or an app on their mobile phone to communicate or email with their regular practice about a medical question or concern. The CMWF average is 27%. 50% of Canadian primary care physicians’ practices offered patients the option to communicate with their practice via email or a secure website about a medical question or concern. The CMWF average is 75%.
- 14% of Canadians used a secure website or patient portal or an app on their mobile phone to request prescription refills from their regular practice. A CMWF average could not be calculated. 24% of Canadian primary care physicians’ practices offered patients the option to request prescription renewals/refills online (not including email).The CMWF average is 58%.
Notes
* As this question was not posed in all participating countries, a CMWF average could not be calculated.
† Canada’s results are significantly lower than the CMWF average.
A higher percentage is more desirable.
Excludes those who did not have email, a smartphone or a computer.
Includes only respondents who have a doctor or place they usually go to for medical care.
Sources
International Health Policy Survey of the General Population, 2023, and International Health Policy Survey of Primary Care Physicians, 2022, The Commonwealth Fund.
Use of electronic health information and communication tools, including virtual care, has been increasing in Canada; however, continued efforts are needed to improve the availability and adoption of these tools. Digital health tools can help improve the efficiency and efficacy of health service delivery and have the potential to increase access to care.
References
1.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. The Milbank Quarterly. 2005.
2.
Shi L. The impact of primary care: A focused review. Scientifica. 2012.
3.
Parkinson B, Meacock R, Checkland K, Sutton M. How sensitive are avoidable emergency department attendances to primary care quality? Retrospective observational study. BMJ Quality & Safety. 2021.
4.
Canadian Institute for Health Information. The Expansion of Virtual Care in Canada: New Data and Information. 2023.
5.
Canadian Institute for Health Information. Access to care remains challenging. Accessed January 4, 2024.