The Sources of Attitudes on the Canadian Healthcare System

Stuart N. Soroka
McGill University

Patrick Fournier
Université de Montréal

This report relies on statistical regression analyses of individual survey data to identify the factors that explain Canadians’ attitudes toward healthcare. Moving beyond the examination of aggregate patterns in public opinion about health allows us to determine the sources and reasons behind the perceptions and preferences held by citizens.
Various sources of evidence are assessed. First, Environics’ Focus Canada series provides an overview of the current state of healthcare attitudes up until 2010. Then, four representative opinion surveys from the last decade (Canadian Election Studies 2000–2008) are combined with a new database capturing the content of media coverage during election campaigns. These analyses focus on the correlates of four topics: healthcare issue salience (or the prominence of healthcare issues), spending on healthcare, support for private hospitals and support for paying to obtain quicker access. The key findings of this section are the following:

  • Women are more likely than men to consider healthcare important, to want to augment health spending and to oppose a two-tier system.
  • Education tends to reduce the salience of healthcare and the need for more expenditures. Wealthier individuals are more supportive of privatized healthcare.
  • Atlantic residents show greater levels of support for the system and spending, while residents of Western Canada show the opposite pattern. Both Quebecers and Westerners tolerate privatization to a greater extent.
  • Exposure to the mass media affects healthcare opinions. People who watch television and read newspapers more frequently have a slightly greater tendency to name health as an important issue and to support an increase in government healthcare budgets.
  • Canadians are influenced by the actual volume of media discussion about healthcare, across elections. In years when health is more prevalent in the media, issue salience is more widespread, there is more support for healthcare spending, private hospitals are less accepted and paying to jump the queue is less endorsed.
  • There are indications that the daily variations in health media coverage during the course of an electoral campaign have an impact on the opinions expressed on a given day.

The Commonwealth Fund’s 2007 International Health Policy Survey of Canadians was also analyzed, specifically to assess people’s experiences with the healthcare system and whether direct encounters had an effect on overall assessments of the quality and safety of the system. The main findings of this analysis include:

  • Women exhibit less confidence about healthcare than men. 
  • Those aged between 30 and 64 are less optimistic than younger and older cohorts. 
  • Individuals with higher education and higher income have less positive evaluations of the
    healthcare system. 
  • Assessments of healthcare vary as a function of different types of experience with the healthcare system. Hospitalization is linked to increases in positive ratings. Furthermore, people treated for life-threatening ailments such as cancer and heart disease, often requiring hospitalization, tend to demonstrate more confidence in healthcare than people who are treated for conditions such as asthma and chronic pain. 
  • Having to wait for services has a marked impact on attitudes about the healthcare system. Waiting for access to emergency room services or appointments with a doctor is associated with increasingly negative attitudes. 
  • Judgments about the quality of care received interact with wait times. While waiting for medical care decreases confidence in healthcare overall, it further decreases when a person has to wait to see a doctor and is dissatisfied with the medical care they receive.

This report establishes that both media content and interactions with the health system influence attitudes about healthcare. In so doing, it makes clear that public opinion can be used as a valuable tool for those interested in healthcare policy. However, the available data do not permit us to directly compare the relative impact of media versus experience—no single survey captures both. Once measures of these two factors are captured in the same survey—a goal that has been set for the 2011 Canadian Election Study— future research ought to distinguish empirically the relative contributions of media exposure and direct experiences in shaping Canadian public opinion toward healthcare.