August 2, 2023 — While about 88% of Canadians 12 and older (not including Quebec) said they had a regular health care provider in national surveys between 2019 and 2021, approximately 12% didn’t.Reference1

Source
Statistics Canada. Custom tabulation based on 2019–2020 and 2021 Canadian Community Health Survey — Annual Component (CCHS). 2023.
 

Having a regular health care provider is important for preventing and treating common health issues, regularly monitoring and treating chronic diseases such as diabetes, and supporting good health. Usually, the provider is a family doctor, general practitioner, nurse or nurse practitioner. Primary care providers screen for diseases, treat medical conditions, give lifestyle advice and provide ongoing care with medication and other treatments. They also refer people to specialists (such as surgeons or heart specialists) when more serious health problems develop. Primary care access can mean better health outcomes, and fewer visits to the emergency department and hospitalizations.Reference2 Yet many Canadians struggle to access a regular health care provider when they need health care or advice.

For those reasons, in February 2023 the Government of Canada and the provincesFootnote i and territories agreed one of their shared health priorities must be ensuring that high-quality primary health care services are there when and where people need them — particularly in rural and remote areas and other underserved communities. This includes working with CIHI and other data partners to develop and report on indicators to measure progress over time.

I have many chronic health conditions and am grateful for my family doctor. I worry about when he retires, as I know few doctors are interested in caring for someone like me. I know my worries would be higher if I lived in a rural area where there are fewer physicians. Perhaps it’s time to explore other solutions to our family doctor crisis, and one might be to look at different pay models for physicians.— Heather Thiessen, Patient Partner, Health Standards Organization, Saskatchewan

This section answers one of the questions we need to ask so we can better understand access to health care: How many Canadians reported having a regular health care provider?

Notes
n/a: Not available.

Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec.

Percentage of population age 12 and older who reported having a regular health care provider.

Since provincial survey data is from 2021 and territorial survey data is from 2019–2020, the findings are not directly comparable.

Due to a small sample size, results from Nunavut should be interpreted with caution.

The numbers in brackets show a range of possible values — the confidence interval — for the estimates from the survey data. This range accounts for the uncertainty of the estimates. For example, a province might have a wide range if there is a small number of survey responses and the results are less stable.

Source
Statistics Canada. Custom tabulation based on 2019–2020 and 2021 Canadian Community Health Survey — Annual Component (CCHS). 2023.
 

Reported access to a regular health care provider differs according to age and where people live:

• Young adults (18 to 34) in the provinces (not including Quebec) are the least likely to have a regular health care provider compared with all other age groups. 
• In the Atlantic provinces, a higher proportion of residents say no health care providers in the area are taking patients. 
• People who live in the Northwest Territories and Nunavut reported less access to a regular health care provider.

Various factors can influence access to a regular care provider. For example, provinces and territories organize and deliver primary health care in different ways. People in rural and remote locations may not have the same access to regular providers as those living in cities. There are staffing challenges in some locations that make it difficult for patients to see the same provider. To address these challenges, some provinces and territories have created community health centres that may be staffed by nurses and temporary physicians.

Older adults are most likely to have a regular care provider, according to an international survey done in 2021.Reference3 Almost all Canadian seniors have a regular doctor, similar to seniors in other developed countries.

My adult child lost his pediatrician once he turned 18 and must find a walk-in clinic any time he needs care. My family doctor is not accepting new patients. I think having multiple clinics in the same neighbourhood work together to provide after-hours and weekend care for patients could help address some of the problems. Being seen on the weekend means people won’t miss work and the kids won’t miss school.— Amy Ma, Patient and Public Advisor, Choosing Wisely Canada, Quebec

Attempts to improve access to regular health care providers across the country have included creating teams of diverse health professionals to provide care, as well as changing the way doctors are paid.

Canadians have options including family doctors, walk-in clinics, family health teams and care that is privately funded, such as insurer-paid services and private virtual care clinics. However it’s accessed, primary care must be available to all Canadians, regardless of age and where they live. It would be useful to collect information on how access to primary care varies according to where people live, sex, income level, language and race to understand if there are differences in access and, if so, how to address them.

The pandemic changed how patients interacted with their doctors: more people received virtual care than ever before.Reference4 More information is needed to understand how virtual care may help improve access to care for Canadians, reduce costs for patients and provide faster access to health care, particularly for those living in rural or remote locations.

One option is for people to have access to nurses, paramedics, EMTs [emergency medical technicians] or others to supplement in-person services. People could receive virtual care from a doctor or nurse practitioner with on-site staff who could see them. The idea is to triage patients — figure out who wants a family doctor, who has an urgent need and start creating an attachment program for the people who need a doctor most. — Dr. Onil Bhattacharyya, Frigon Blau Chair in Family Medicine Research, Women’s College Hospital, Ontario

• Resilient health workforce key to pandemic recovery
• Canadian Community Health Survey, Statistics Canada
• Primary care topic page
• Virtual care in Canada

When COVID-19 hit, scheduled and non-emergency surgeries such as joint replacements and cataract procedures were cancelled or delayed. Hospitals needed to make room for COVID-19 patients and to prioritize urgent and life-saving procedures. Patients may also have chosen to delay their surgeries. At the same time, the supply and availability of health care workers affected which surgeries could be performed. The pattern repeated as further waves of the virus hit. Each interruption in scheduled surgeries added to the backlog.

Notes
Percentage change in number of surgeries done monthly between March 2020 and September 2022, compared with 2019.

Some data is provisional and subject to change; this data should be interpreted with caution.

Source
Discharge Abstract Database and National Ambulatory Care Reporting System, 2018–2019 to 2022–2023, Canadian Institute for Health Information.
 

To reduce their surgical backlogs, provincial and territorial health systems will have to increase their surgeries above pre-pandemic levels. Modest increases in surgeries — between 1% and 9% — were achieved in several months in Canada (not including Quebec) between March 2021 and June 2022.

Before the pandemic, an international survey showed that Canadians reported waiting longer for non-emergency surgeries than people in other developed countries.Reference1 Health systems across Canada have made significant efforts over the past decade to reduce waits for surgeries, and they’re drawing on what they learned from those successes to address pandemic-related waits.

Notes
n/a: Not available.

At the time of calculation, hospital data was not available for Nunavut (November to December 2019, March 2020, January to March 2021). Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec.

Percentage change in number of surgeries done monthly between March 2020 and September 2022, compared with 2019.

Analysis is based on hospital data submitted as of December 31, 2022. Data for April to September 2022 is provisional and is subject to change; this data should be interpreted with caution.

Source
Discharge Abstract Database and National Ambulatory Care Reporting System, 2018–2019 to 2022–2023, Canadian Institute for Health Information.

Health care workers are the heart of our health care systems. Their supply is a significant factor in how easily Canadians can access primary care and how long patients wait for surgeries and procedures.

During the initial waves of the pandemic, health care workers on the front lines in hospitals and long-term care homes were at high risk of catching the virus and exhausted by caring for sick patients while encased in protective gear. The 18 million overtime hours worked in Canada’s public hospitals in 2020–2021 is the equivalent of more than 9,000 full-time jobs, which gives a sense of the increased workload during the pandemic’s first year. The pressure contributed to burnout and illness, which can have long-term implications for the health of workers and for health care systems.Reference2 Some workers changed jobs and even careers.

Patient access to care was affected by pandemic lockdowns and redistribution of staff and health system resources, resulting in decreases in non-urgent care and scheduled surgeries. All these factors meant most physicians saw fewer patients. In the first year of the pandemic, physicians provided almost 8% fewer health care services in Canada compared with the previous year. During the same period, total physician payments decreased for the first time in 20 years, by 2%.

When this crisis unfolded, the system was adapting in real time… Cardiac procedures, cancer procedures had relatively smaller percentage reductions than [surgeries for] chronic conditions, like arthritis, for hernia, for pediatric. It shows the system was trying to triage to address the most urgent surgical procedures so that anybody whose life was at risk… they were provided with those opportunities. What suffered was things that aren’t imminently life-threatening but are often very disabling.— Dr. David Urbach, Head of the Department of Surgery, Women’s College Hospital, Ontario

In addition to the recent pandemic impact on health workers, Canada’s supply of doctors and nurses, including nurse practitioners, is changing:

• Many Canadians are struggling to access primary care. One of many factors may be the slowed pace of growth in the number of family physicians over the last 10 years. The annual growth rate decreased from about 3% to about 1% between 2012 and 2021. Nurse practitioners — who can provide many, but not all, primary care services — saw a steady annual growth rate of nearly 10% over the same period. There are still far fewer nurse practitioners compared with other professionals such as registered nurses and family physicians. Nurse practitioners can play an important role in delivering primary care services, particularly in rural and remote areas.Reference3
• The number of nurses has increased in most provinces and territories, but the number working in some health care settings has decreased. The number of registered nurses giving direct patient care in long-term care homes, for example, went down about 2% between 2020 and 2021.

Understanding the supply of health care workers at any point in time will require tracking the number of physicians and nurses, including nurse practitioners, leaving and taking direct care roles in each province and territory.

One of the huge issues we have in this country [is that] there is no human health resource plan that’s pan-Canadian. We don’t have the data so we can look [at whether] we need this many nurse practitioners, we need this many nurses, social workers, et cetera, to really understand how to deliver integrated team-based care across the country in a sustainable way.— Dr. Katharine Smart, Pediatrician, Yukon; Past President, Canadian Medical Association

New health human resources indicators will allow for better assessment of the flow of health care workers in to and out of the system, and for planning and monitoring of progress over time.

Improving Canada’s health care systems will depend on getting the right mix and number of health care providers so they’re available when Canadians need them. We know the supply of nurses and physicians is growing overall, but there is much to learn about whether we are educating enough new professionals and how and where they will be needed. We will need to protect providers from burnout, and explore different ways of delivering care that may be able to support health care workers and their work–life balance. We will need a resilient health care workforce to address the surgical backlogs and meet the evolving health care needs of Canadians.

• Access and wait time information at CIHI
• Health workforce at CIHI
• The state of the health workforce in Canada, 2022 
• Health workforce in Canada: In focus (including nurses and physicians)
• Impact of COVID-19 on Canada’s health care systems

Mental health and substance use issues often start during adolescence, and 70% of people living with a mental illness experience symptoms before the age of 18. It’s estimated that up to 20% of children and youth in Canada — approximately 1.2 million young people — are affected by a mental health disorder.Reference4 Meeting the mental health needs of children and youth builds a foundation for health and well-being throughout their lives.

Services for youth are often fragmented, which makes it hard to find the right care. Then, when people turn 18, they must switch to adult services. Not only does this mean starting the search for care again, but the available services aren’t tailored to youth, don’t necessarily meet their needs and may have long waits.

The integrated youth services approach was developed to address long-standing problems — limited, fragmented services and uneven quality of care — that keep youth (age 12 to 25) from getting the help they need. The goal is to make youth mental health and substance use services easier to find and use by bringing together all the types of supports young people may need in one place.

Many of the integrated youth services sites across the country are new or just getting started. A core component of integrated youth services is measurement-based care. Integrated youth services providers understand it is important to measure outcomes through shared data systems, common evaluation tools and research studies. While we don’t yet have enough information to report on this indicator, here is a glimpse at some of the benefits integrated youth services offer:

• They provide easily accessible, youth-friendly and inclusive services to help reach youth who traditionally face barriers to mental health and substance use care.
• They work with community partners to bring a range of community resources to youth, blending help for mental health and substance use with primary health care and social services such as employment, housing and education supports.
• They are planned together with youth and family members and guided by shared principles so they meet the specific needs of the youth and communities they serve.
• They have spread across the country to help vulnerable youth, with at least one site operating or starting up in most provinces and territories. Some are designed just for Indigenous communities and incorporate traditional Indigenous healing and cultural practices. There is still work to do to address some of the challenges in remote communities, such as limited human resources.
• They study the kinds of care offered and measure results so improvements can be based on evidence of what works, what doesn’t and what’s still needed but missing.

Notes
n/a: Not available.

Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec. Newfoundland and Labrador is currently undertaking planning related to this indicator. Data is not available at this time for the number of sites under development.

† Saskatchewan has a minimum of 3 sites in development.

‡ In Alberta, Kickstand is the initiative represented in pan-Canadian activities.

§ British Columbia has 14 active in-person sites and 1 active virtual site.

The type and number of integrated youth services sites shown is a snapshot of provincially/territorially funded integrated youth services delivery sites that were part of provincial/territorial or pan-Canadian networks at the time this report was prepared.

Source
Provincial/territorial and pan-Canadian representatives of integrated youth services networks, 2023.

A 2018 survey of Canadians age 12 and older found that just over 14% reported being diagnosed with a mood or anxiety disorder (not including Quebec). Among those people,

• Nearly 8% reported they’d needed mental health care in the past 12 months but had not received it
• Another almost 20% reported they’d received some mental health care in the past 12 months but that it had only partially met their needs

Taken together, this means more than one-quarter of Canadians (not including Quebec) with a diagnosed mood or anxiety disorder — more than 851,000 people — reported in 2018 at least some unmet mental health care needs in the past 12 months. People with mood or anxiety disorders were twice as likely to have their need for mental health care unmet as people with other mental health issues.Reference5 Without formal care for mental health problems, symptoms can get worse.

Source
Statistics Canada. Custom tabulation based on 2018 Canadian Community Health Survey — Annual Component (CCHS). 2023.

Notes
n/a: Not available.

Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec.

Percentage of Canadians age 12 and older who reported having a diagnosed mood or anxiety disorder and that their perceived needs for mental health care were not met in the last 12 months (not including Quebec).

Mental health care includes information, medication, counselling and other services.

This indicator is based on those who reported being diagnosed with a mood or anxiety disorder. Provincial differences in the rate of diagnosis or in processes involved in receiving a diagnosis could affect the comparability of results between provinces.

The numbers in brackets show a range of possible values — the confidence interval — for the estimates from the survey data. This range accounts for the uncertainty of the estimates. For example, a province might have a wide range if there is a small number of survey responses and the results are less stable.

Source
Statistics Canada. Custom tabulation based on 2018 Canadian Community Health Survey — Annual Component (CCHS). 2023.
 

These results do not provide the full picture of unmet mental health needs. From more recent data we know that during the fall of 2020 — as the second wave of the COVID-19 pandemic spread across the country — almost 1 in 5 Canadians 12 and older reported needing mental health care in the last year. Of those people, nearly 1 in 2 felt their needs were unmet or only partially met. When Canadians who reported a need for mental health care were asked why it hadn’t been met, they gave reasons such as not knowing where to go or not having enough money to pay for care. 1 in 4 said they preferred to manage their needs themselves.Reference6

This data can’t tell us the impact of not having needs met or anything about people who didn’t look for mental health care. The COVID-19 pandemic increased mental health needs but also brought different ways of getting care, such as videoconferencing, phone calls, even texting, which might have made it easier for some people to find treatment and support.

It is very difficult across Canada to access psychological services, whether it’s psychologists, social workers or specialized educators. There are long waiting lists and given that many young people are experiencing an increase in distress and anxiety symptoms, it’s urgent that we focus our action on them. Parents want to know what they can do to help their kids.— Dr. Nicholas Chadi, pediatrician, Sainte-Justine University Hospital Centre, Quebec

Getting care quickly may prevent visits to emergency departments and hospital stays and can lead to better long-term mental health.

Note
This indicator measures the median number of days that clients waited for community mental health counselling and includes only publicly funded services that are scheduled in advance.

Sources
Provincial and territorial data collection systems, 2020.
 

Key questions as governments work to make high-quality mental health services more available include

• Are Canadians able to access the care they need?
• Are they getting care quickly enough?
• How do people feel about their experience getting care?

Notes
n/a: Not available.

No data is available at this time for Prince Edward Island, Quebec, Ontario and Nunavut.

— Alberta results are not shown due to incomplete data coverage but are included in the calculation of the Canada value.

Median number of days waited for community mental health counselling.

Includes only publicly funded services that are scheduled in advance.

For Nova Scotia, Manitoba, Saskatchewan, British Columbia and Yukon, results are based on partial data coverage.

Caution should be used when interpreting this data. The data comes from independent provincial and territorial systems, which have known variations in definitions.

Sources
Provincial and territorial data collection systems, 2020.
 

In some places, waits for mental health counselling services are longer for children and youth than for adults 18 and older. Children and youth make up about one-third of the total volume of referrals for mental health counselling.Reference7

We know there are differences in how provinces and territories deliver services, collect data and report it.  Many things affect how long a person waits for counselling, including

• What services are available, including differences between publicly funded and privately delivered services
• How easy it is to make their way through the system
• Community and cultural factors that affect the need for care 
• Realities such as income level, social and family support, education and where they live 
• Stigma, which can discourage people from asking for help
• How severe a person’s need is
• The availability or scheduling preferences of the person receiving services

Accessing mental health care takes a very long time, even when a youth is in crisis for months. About 5 months prior to being hospitalized the first time, my family doctor advised my parents to take me to hospital due to being in a mental health crisis. Even when a youth goes to the emergency department suicidal, you get sent back home without care and put on a wait-list.— Hannah, 19, Ontario

Better access to mental health and substance use care is important for millions of Canadians. While challenges are widespread across the country, information about who is affected, what services are available, and who is and is not getting support is unevenly gathered. If we are going to improve access to effective mental health and substance-use supports, we have to work on understanding the needs of different groups (such as by sex, income level, language and race). We have to understand the barriers that keep people from getting care and find out which ways of organizing and delivering care work best.

• Mental health and substance use at CIHI
• Wait Times for Community Mental Health Counselling indicator

Source
Canada Health Infoway. Survey question: “Have you ever accessed this digitally enabled health service at anytime in the past? Access your own personal health information electronically.” Custom tabulation based on 2022 Canadian Digital Health Survey: What Canadians Think. 2023.
 

Canadians need health systems that run on the best available information systems and digital tools.

Digital access to the health care system is important to Canadians. 4 out of 5 would like to access their health information electronically — whether that’s to book appointments, get in touch with their nurses and physicians or get test results. More than 80% of Canadians who have gone online to see their health information felt more informed and better able to manage their health. And some patients even say they were able to avoid a visit with their regular health care provider or to an emergency department because they could see their health information online.Reference4

I’ve been using digital health for about a year and primarily I use it to update information for my daughters, connect with service providers, and stay up to date on immunizations and ask questions. So being able to email a nurse at my local health centre, … being able to ask questions and figure out … should I be more concerned about something… I find it really helpful. — Toni Williams, British Columbia, a mother who accesses her family’s health information online through Canada Health Infoway’s Closing the Circle of Care Project Reference5

Notes
n/a: Not available.

Results for P.E.I. and the territories are not available due to small sample sizes. Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec.

Although weighting methods were applied to the survey, it is important to note that with the exclusion of Quebec the results do not reflect a nationally representative sample. Caution should be used when interpreting this data and when comparing results among provinces.

Source
Canada Health Infoway. Survey question: “Have you ever accessed this digitally enabled health service at anytime in the past? Access your own personal health information electronically.” Custom tabulation based on 2022 Canadian Digital Health Survey: What Canadians Think. 2023.
 

Electronic access increases with age and is higher among those with a family physician. But Canadians say some types of information are easier to get than others. For example, results for lab and diagnostic tests are more available than a list of medications.Reference4

Sources
Canadian Medical Association and Canada Health Infoway. Survey question: “Please indicate which of the following aspects of clinical care communication between providers occurs electronically directly from/to your practice system (not via fax). Exchange of patient clinical summaries with doctors outside practice.” Custom tabulation based on 2021 National Survey of Canadian Physicians. 2023.
 

Sharing information from their patients’ electronic records with other physicians is more common for doctors who work in hospitals than for those who work in the community. (Three-quarters of Canadian physicians receive lab tests and diagnostic results electronically.)Reference6

Other types of health care providers also have low rates of exchanging information electronically. In 2022, just over half of Canadian pharmacists reported sharing patient information electronically,Reference7 and in 2020, slightly less than a third of nurses said they did.Reference8

Notes
n/a: Not available.

Results for the territories are not available due to small sample sizes. Quebec is not participating in the joint reporting exercise stemming from A Common Statement of Principles on Shared Health Priorities. Therefore, results are not available for Quebec. Results for the Atlantic provinces have been combined due to small sample sizes.

Although weighting methods were applied to the survey, it is important to note that with the exclusion of Quebec the results do not reflect a nationally representative sample. Caution should be used when interpreting this data and when comparing results among provinces.

Sources
Canadian Medical Association and Canada Health Infoway. Survey question: “Please indicate which of the following aspects of clinical care communication between providers occurs electronically directly from/to your practice system (not via fax). Exchange of patient clinical summaries with doctors outside practice.” Custom tabulation based on 2021 National Survey of Canadian Physicians. 2023.
 

The low level of electronic communication in Canada’s health systems is a concern because it may be putting patients at risk. Safe, effective care depends on providers at every level having all the information they need to treat a patient. A 2022 survey of doctors, nurses and other health care workers found the number one barrier to sharing patient information between providers is a lack of common technical standards for exchanging information.Reference3

International surveys show the percentage of Canadian primary care physicians who can share summaries of patient information electronically with other doctors is increasing (to 38% in 2022 from 25% in 2019) but is still below the average of other developed countries (67% in 2022).Reference9

Modern information systems are also key tools for understanding trends in illnesses and broader population health, as well as which treatments do or don’t work. They will also be essential for managing another health care crisis such as the COVID-19 pandemic.

I was on call last week and I’m looking at laboratory reports, at X-rays, I’m talking to a specialist. I’m talking to the family or the patient. I’m gathering all this information and then crafting an approach to care. If I’m missing some of that information, or it is inaccessible, or I do not know it exists because it’s on a different platform, the likelihood of my making an error increases.— Dr. Ewan Affleck, Senior Medical Advisor for Health Informatics, College of Physicians and Surgeons of Alberta; Chair, Alberta Virtual Care Coordinating Body; Acute Care Physician, Northwest Territories

It will be important to understand barriers that can hinder access to electronic health information.

For example, electronic tools depend on pan-Canadian high-speed internet, which remains a challenge in many parts of the country. People who live in rural or remote areas or who have lower incomes may be less likely to have the internet they need to use online health tools.

It would be useful to collect information on how access to electronic health information varies according to age group, sex, income level and language and, if there are differences, how to address them.

As well, patients may need information to be translated into other languages, and people with disabilities will need software or other devices to access their electronic records.

Another issue is the need to help patients understand the technical language of health care so they can use the information in their electronic records to manage their health.

More information is needed to understand how better sharing of health information impacts wait times for patients, health outcomes, and patient and provider care experiences.

• Virtual care in Canada
• Commonwealth Fund survey, 2022
• Dr. Ewan Affleck — Virtual Care in Canada (podcast episode)

• CIHI’s First Nations, Inuit and Métis health web page