Canadians' Perceptions of the "Health Allowance System"

Open to debating the concept, Canadians perceive the "health allowance system" to offer both advantages and disadvantages in comparison to the current health care system, according to a National Angus Reid Poll commissioned by the Toronto-based Consumer Policy Institute which was conducted among 1,515 Canadians between September 18 and 24, 1997.

The majority of Canadians agree that the health allowance system could offer cost savings from responsible use of the system (72%), allow patients to choose services specifically suited to their needs (67%), and elevate physician accountability (55%). However, the majority of Canadians also feel that the health allowance system could increase government administration (70%), lead to higher costs to the system from the use of services not currently covered by medicare (55%), and encourage people to ignore potential minor health problems (54%).

As well, the majority (65%) of Canadians would prefer to choose their health care services, compared to one-third (32%) of respondents who would prefer the government to make these health care decisions. Further, respondents are split as to the health care allowance system being better (29%) or worse (30%) than the current system, with a higher proportion of Canadians perceiving it to be neither better nor worse (37%) than the present system. Overall, the majority of Canadians (60%) would support the health allowance system if costs were the same and seven in ten (70%) would support it if costs were lower than what is currently being spent. However, support for this system drops significantly (to 23%) if the costs were to rise above what is presently being spent on health care. The definition of the health allowance system given to survey respondents is as follows:

• A group of Canadians has come up with an idea for reorganizing the health care system. In this new system, the government would provide each Canadian with an individual "health allowance". This allowance would always be sufficient to cover health services that are currently covered by provincial health plans, and the unused portion in one year could be used in future years for drugs, dental work, chiropractic and other currently uninsured services.

The highlights of the poll findings include:

ADVANTAGES: COST SAVINGS, CHOICE AND ACCOUNTABILITY

Canadians agree that the health allowance system could offer certain advantages such as cost savings from responsible use of the system (72%), allowing patients to choose services specifically suited to their needs (67%), and elevating physician accountability (55%). (Table 1)

• Over seven in ten (72%) Canadians agree that, "because the health allowance system would make Canadians more aware of the true cost of health care services, they would use the services more carefully". More specifically, just over four in ten (41%) "strongly agree" and just over three in ten (31%) "moderately agree" with this statement. In comparison, under three in ten (27%) Canadians either "strongly" (13%) or "moderately" (14%) disagree that Canadians would use services more carefully under the health allowance system. One percent (1%) are undecided.
• Residents of Alberta and the Atlantic provinces (76%, respectively), younger Canadians aged 18 to 34 (79%), and the least affluent (76% among those with annual household incomes of less than $30,000) tend to be more likely to agree with this statement.
• Conversely, residents of Ontario (30%), the university educated (31%), the most affluent (30% among those with annual household incomes of $60,000 or more), Canadians aged 35 to 54 (30%), as well as those aged 55 and older (30%) are more likely than other subgroups surveyed to disagree with this statement.
• Two-thirds (67%) of Canadians either "strongly" (31%) or "moderately" (36%) agree that "the health allowance system would ultimately promote better health for Canadians because the unused portion of the allowance could be used to pay for therapies not currently covered by medicare, allowing people to choose services more suited to their own health needs". On the other hand, three in ten (30%) Canadians either "somewhat" (15%) or "moderately" (15%) disagree with this statement. Three percent (3%) are undecided.
• Agreement with this statement is disproportionately more likely to occur among Atlantic Canadians (72%), Albertans (71%), younger Canadians aged 18 to 34 (74%), middle-income earners (71% among those with annual household incomes of between $30,000 and $59,999), and those with a highschool education (72%) or some post-secondary education (71%).
• Disagreement with this statement is more likely found among the most affluent Canadians (35% among those with annual household incomes of $60,000 or more) and the university-educated (37%).
• The majority (55%) of Canadians either "strongly" (27%) or "moderately" (28%) agree that, "because we would be paying our doctors directly, the health allowance system would make my doctor more accountable to me, and foster a more professional and personal relationship between us". Over four in ten (42%) Canadians either "strongly" (22%) or "moderately" (20%) disagree with this statement, and three percent (3%) are undecided. (Table 1)
• Canadians more likely to agree that the health allowance system will make their doctor more accountable to them include residents of Quebec (61%) and those aged 18 to 34 (64%).
• Disagreement with this statement is disproportionately more likely to be found among residents of British Columbia (48%) and the university-educated (48%).

DISADVANTAGES: ADMINISTRATION, INCREASED COSTS AND IGNORING HEALTH NEEDS

A majority of Canadians feel that the health allowance system would be disadvantageous with regard to increased government administration (70%), higher costs to the system from the use of services not currently covered by medicare (55%), and encouraging people to ignore potential minor health problems (54%). (Table 2)

• Seven in ten (70%) Canadians either "strongly" (40%) or "moderately" (30%) agree that, "an individual health allowance for each Canadian would require more government administration than the current health care system". In comparison, just under one-quarter (24%) either "strongly" (8%) or "moderately" (16%) disagree with this statement and six percent (6%) are undecided.
• Agreement with this statement is consistent across socio-demographic variables evaluated. However, disagreement is more likely to occur among those without a highschool education (29%).
• The majority (55%) of Canadians either "strongly" (24%) or "moderately" (31%) agree that, "people would use up all of their health allowance each year by increasing their use of services that are not currently paid for by medicare, and this would drive up overall costs to the health care system". Conversely, over four in ten (42%) Canadians either "strongly" (14%) or "moderately" (28%) disagree with this statement. Three percent (3%) are undecided.
• Those who are more likely to agree with this statement include younger Canadians aged 18 to 34 (59%) and those with a highschool education (61%).
• Disagreement with this statement is more likely to occur among residents of Atlantic Canada (49%), residents of Saskatchewan/Manitoba (47%), those aged 35 to 54 (47%), the university-educated (49%) and the most affluent (46% among those with annual household incomes of $60,000 or more).
• The majority (54%) of Canadians either "strongly" (26%) or "moderately" (28%) agree that, "to save their health allowance for future needs, this system would encourage people to ignore minor health problems which, if left untended, would develop into serious problems in the long run". In comparison, under one-half (45%) of Canadians either "strongly" (19%) or "moderately" (26%) disagree with this statement and two percent (2%) are undecided.
• Agreement is disproportionately higher among younger Canadians aged 18 to 34 (58%), those with a highschool education (58%) and the least affluent (59% among those with annual household incomes of les than $30,000).
• On the other hand, disagreement is more likely found among the university-educated (49%) and the most affluent (49% among those with annual household incomes of $60,000 or more).

INDIVIDUAL CHOICE OF HEALTH CARE SERVICES

All survey respondents were read the following information: "Each individual uses the health care system differently. Some people make frequent use of services that are covered by provincial health plans, such as doctor's visits, and other people make greater use of uninsured services, such as prescription drugs, dental care or chiropractic services". (Table 3)

• Based on this information, two-thirds (65%) of Canadians feel that, "it should be up to individual Canadians to decide for themselves which health care services medicare should cover for them, based on the type of services they actually use". In comparison, one-third (32%) of respondents think that "these decisions are too complicated for most individuals to make themselves, and should be left up to governments who study the issues and know the costs of services". Three percent (3%) are undecided.
• Those predominantly more likely to feel that "individual Canadians should decide for themselves" include Western Canadians (76% among British Columbians, 71% among those in Saskatchewan/Manitoba, and 70% among Albertans) and younger Canadians aged 18 to 34 years (70%).
• Conversely, those more likely to feel that health care decisions are too complicated and should be left up to governments tend to be residents of Quebec (38%) and Canadians aged 55 years and older (38%).

COMPARING THE HEALTH CARE ALLOWANCE SYSTEM TO THE CURRENT SYSTEM

In meeting the health care needs of Canadians, respondents are split as to the health care allowance being better (29%) or worse (30%). A somewhat higher proportion of Canadians perceive the health care allowance system to be neither better nor worse (37%) than the current system. Five percent (5%) are undecided. (Table 4)

• Respondents who indicate that they feel the health care allowance would be better than the current system are more prone to be residents of Atlantic Canada (40%) and aged between 18 and 34 years (36%).
• To the contrary, those who are predominantly more likely to feel that the health care allowance would be worse than the current system tend to be those aged 55 years and older (34%) and the university-educated (34%).
• As well, Canadians disproportionately more likely to indicate that the health allowance system will be neither better nor worse than the current system include residents of Quebec (41%).

COST IMPLICATIONS

The majority of Canadians (60%) would support the health allowance system if costs were the same and seven in ten (70%) would support it if costs were lower than what is currently spent. However, support for this system drops significantly (23%) if the costs were to rise above what is presently being spent on health care. (Table 5)

• Seven in ten Canadians (70%) would favour the health care allowance system if it cost less than the current system. One-quarter (26%) of Canadians would not favour this system even if it cost less than the current health care system and four percent (4%) are undecided.
• Those disproportionately more likely to favour the health care allowance system if it cost less than the current system include residents of Quebec (77%), Atlantic Canadians (75%), those in Saskatchewan/Manitoba (74%), those aged 55 years and older (77%), those without a highschool education (74%) and the least affluent (77% among those with annual household incomes of less than $30,000).
• Conversely, those more likely to indicate that they would not favour this system even if it cost less than the current system tend to be residents of Ontario (33%) and the most affluent (30% among those with annual household incomes of $60,000 or more.
• Further, if the health care allowance system cost the same as the present system, the majority (60%) of Canadians report that they would favour the system, compared to just over one-third (35%) who would not. Five percent (5%) are undecided.
• Almost three-quarters (73%) of Canadians would not be in favour of the health care allowance system if it cost more than the current system. In comparison, just under one-quarter (23%) of Canadians indicate that they would be in favour of this system if it did cost more than the present system. Four percent (4%) are undecided.
• Residents of British Columbia (78%) and Quebec (78%) are more likely than other subgroups of the survey population to indicate that they would not be in favour of the health care allowance system if it cost more than the present system.
• On the other hand, residents of Saskatchewan/Manitoba (30%), Atlantic Canadians (29%) and those aged between 18 and 34 years (27%) are more likely to favour this system even if it cost more than the current health care system.
• The Consumer Policy Institute (CPI) is a division of Energy Probe Research Foundation, a federally recognized charitable organization incorporated in 1980. CPI focuses on the social and economic needs of individuals and communities. (Web address: www.nextcity.com/main/cpi/cpi.htm)

This poll was conducted by telephone between September 18 and 24, 1997 among a random and representative cross-section of 1,515 Canadian adults.

These data were statistically weighted to ensure the sample's regional and age/sex composition reflects that of the actual Canadian population according to the 1991 and 1996 Census data.

With a national sample of 1,515, one can say with 95 percent certainty that the results are within ±2.5 percentage points of what they would have been had the entire adult Canadian population been polled. The margin of error will be larger within regions and for other sub-groupings of the survey population.

For more information on this news release, please contact:

Lawrence Soloman
Executive Director
Consumer Policy Institute
(416) 964-9223, Ext. 241

John Wright
Senior Vice-President
Angus Reid Group
(416) 324-2900