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Cost a barrier for 'sicker' Canadians in need of health care: report

Canadians with chronic conditions are frequent users of the health-care system, but a new report shows many experience considerable difficulty getting the medical treatment they need.

So-called sicker Canadians – most of whom are age 50 or older – have one or more of seven chronic conditions: high blood pressure, heart disease, cancer, diabetes, joint pain or arthritis, chronic lung problems such as asthma or chronic obstructive pulmonary disease (COPD), and mental health problems such as depression or anxiety.

Those who are chronically ill are among the highest users of health services: they are more likely to be hospitalized, have surgery, visit emergency departments and take prescription medications.

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But cost can be a major barrier to accessing that care, says the Health Council of Canada, citing results from the 2011 Commonwealth Fund International Health Policy Survey, which included almost 4,000 Canadians.

Almost a quarter of respondents who rated their health as fair or poor reported skipping a dose of medication or not filling a prescription due to the cost, compared with just 10 per cent of other Canadians, the survey found.

The council said that one-in-four ratio is significant because 90 per cent of sicker Canadians take at least one prescription drug, while 54 per cent take four or more medications. As well, about one in eight said they have skipped a recommended test or follow-up treatment due to cost concerns, compared to just five per cent of those without chronic health problems.

"The experiences of patients with chronic conditions can tell us a lot about the quality of the health-care system as a whole and the progress we have made," council CEO John Abbott said in a statement Monday. "The data here tells us we need to be concerned that there are many Canadians who still cannot afford treatment of their chronic conditions.

"We need to address this immediately, because medications that prevent complications from chronic disease are vital in contributing to better quality of life for individuals, and reduced health-care costs for the system."

Almost 60 per cent of those with ongoing health concerns have below-average household incomes, making it difficult to afford certain types of care and medications. Secondary costs such as paying for transportation to appointments, child care and lost wages from time away from work can also present obstacles to care, the Health Council said.

In fact, 12 per cent of sicker patients reported not visiting a doctor due to cost concerns, compared with just four per cent of other Canadians. Over a quarter of health-care services are paid for through private sources, either out-of-pocket by patients or through private insurance.

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The survey also found that this group of patients fares worse when it comes to co-ordination of care. People with chronic conditions are likely to see multiple providers and specialists, yet many said they didn't always receive help from their doctor's office in co-ordinating that care.

About half of patients had to wait a month or longer to see a specialist, while almost one-quarter said test results or medical records were not available when they arrived for their appointments.

The survey showed sicker Canadians felt less engaged in their health care compared with others in the country. Overall, 36 per cent said their doctors didn't explain their health concerns in an easily understood manner and 45 per cent felt they did not get enough time with their physician.

"It's important that doctors know my medical history and are up to speed on my health results," said Frank Austin, a stroke survivor and patient advocate. "There needs to be improved communication among health-care providers so that time is not wasted and the risk of errors in my care is reduced."

Still, there were some positive results from respondents with chronic conditions: more had a regular doctor or clinic for care – 96 per cent versus 86 per cent of the general population. They also found it easier to get care after-hours or to get an appointment with a doctor the same or next day.

While such results are promising, the council said much improvement is needed.

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The report recommends a number of ways to eliminate cost barriers, including increasing use of alternatives to face-to-face visits, such as telemedicine, e-mail and phone consultations. To improve co-ordination of care, widespread use of electronic medical records in Canada would reduce costs and improve efficiency, the council said.

The 2011 Commonwealth Fund International Health Policy survey involved about 19,000 randomly chosen adults from 11 countries, who were interviewed by telephone between March and June.

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