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Health-care efficiency seen as more critical than funds, survey finds

Emily Nicholas, 29, is photographed exercising with her yoga ball in her Toronto home on Dec 20 2011. After a stress fracture in her leg was misdiagnosed, she eventually broke it in a fall and has since undergone several operations to correct the problem.

Fred Lum/Fred Lum/The Globe and Mail

Otto Akkerman of Environics Research will be online at at 1 p.m. (ET) Wednesday to take your questions about this poll. Leave a question in advance for Mr. Akkerman by clicking here.

Although Canadians are fond of their health-care system, a growing majority believe more money from governments isn't the sole answer to fixing medicare – it needs to be more efficient.

That sentiment, captured in a new Environics survey, suggests the public is receptive to federal Finance Minister Jim Flaherty's assertion that transfers of funds to the provinces for health care can't keep growing at the same high level. Canadians and many others in the 28 countries surveyed between August and October are saying: "Let's look for efficiency first and money second," said Otto Akkerman, senior vice-president of health and pharma for Environics Research Group.

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As provincial governments – especially those in the East – decry federal plans to reduce the annual increases in health funding over the next decade, nearly two-thirds of Canadians believe inefficient management is the chief problem, up from 54 per cent in a 2004 poll. Only 30 per cent pointed to lack of money.

"Nobody is asking me, as the minister of health and wellness, to simply throw more money at the system," Alberta Health Minister Fred Horne said. "Albertans know that doesn't get them better outcomes."

Of the G8 nations surveyed, Canada was the only one in which a majority [52 per cent]held a positive view of their health system. And yet, Canadians face one of the most challenging economic issues of their time: how best to sustain the $192-billion a year system as the population ages.

The Canadian part of the survey, done in August, questioned online 1,006 people aged 18 and older.

The More Patients Use It, the Less They Like it

Emily Nicholas thought the health care system was good. Then she got a reality check: a stress fracture on her hip was not accurately diagnosed – in part because she says no one listened to her – leading to an eight-year odyssey through the system. Four operations later, including a full right hip replacement and formal physiotherapy that ended only a few months ago, Ms. Nicholas now uses the word "mediocre" to describe medicare.

"It's not very sensible or innovative," said Ms. Nicholas, 29, a private tutor of calculus and science for high school and university students. "There's too much focus on more diagnostics, more tests, when listening and communication could diminish the need for some of those."

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Her views fit with the Environics poll, which found those who use the system more frequently like it less. Canadians who took prescription medication for a chronic condition [53 per cent]are more likely to state that the system is either in or heading to a state of crisis.

As well, those who take medication for a chronic condition are less likely than others to believe the system does a good job of caring for the health of the more vulnerable in society and are less confident that services will always be there when they need them.

Public Versus Private

Like most Canadians, Jill Docking strongly supports universal access to health care. Diagnosed with rheumatoid arthritis at the age of 15, the Regina resident has long relied on the medical system for treatments and operations to help her cope with her chronic illness.

But she's not against experimenting with different ways of delivering care within the public model, including incorporating the private sector, especially if such measures reduce waits for operations.

In the mid-1990s, Ms. Docking, now 55, waited three years for knee-replacement surgery. She worked full time at the student registries front desk at the University of Regina while on the waiting list. The pain was so bad that at times she couldn't stand. At home, she dreaded getting up in the middle of the night to use the bathroom.

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"The pain was excruciating. I was in pretty rough shape," she recalled. "Any way you can treat people in a timely fashion is the way to go, however you do it."

In Canada, preference for a government-funded health system remains high at 77 per cent, the 2011 Environics survey showed. The figure is virtually unchanged from 2004. However, a survey last year found that just over half of respondents agreed that Canadians should have the right to buy private care if the wait for treatment is too long.

Improving the system

Increasingly, Canadians don't believe inadequate funding is the main source of strains. According to the Environics survey, 62 per cent cite inefficient management as the chief problem. The sentiment was shared in 23 of the 28 countries surveyed for the global health snapshot.

Kevin Leonard, who has lived with Crohn's disease for four decades, points to inefficiency as a major problem. When he went for an ultrasound of his abdomen a few years ago, a frustrating encounter reinforced his belief that patients need better access to their health records. His radiologist folded a report on his exam and stapled it 17 times to hide the results until he saw his family doctor.

"It's very, very ineffective the way it runs today," said the 54-year-old professor at University of Toronto's Institute of Health Policy, Management and Evaluation. "It's based on this mindset that's rampant throughout health care that the patient is either not mature enough or does not have the right to get access to their own information until a doctor has said it's okay for you to have that."

Prof. Leonard believes allowing patients to view their medical records online would help them track changes in their health and improve management of chronic illnesses.

Leave a question for Otto Akkerman of Environics Research at our live discussion page, and check back beginning at 1 p.m. (ET) on Dec. 21 to participate in the event.

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