© Copyright 2000 Rogers Media. The following article first appeared in the June 2000 edition of BENEFITS CANADA magazine.

Canadian healthcare checkup

Plan members are becoming increasingly disenchanted with Canada's healthcare system. New research shows a growing number are looking to you for help.

By Kevin Press

Canadian members of employer-sponsored benefits plans are losing faith in the public healthcare system--albeit gradually--but their view of employer-sponsored plans remains generally positive. That message is from Aventis Pharma's third annual Canadian Consumer Survey on Healthcare (conducted by The Angus Reid Group), released in May. The findings come from over 1,500 plan members who were surveyed by phone this past February and March.

"This is a consistent message that we've heard three years in a row," says Sanjiv Sharma, director, health policy, strategic planning at Aventis Pharma in Laval, Que. "Healthcare benefits are extremely important to Canadians. It is very important that plan sponsors understand that."

There are several key points in this year's study. Of all aspects of the benefits plan, drug coverage is ranked most important by plan members. Plan members want new drugs covered too, but where price demands, most are ready to chip in with higher premiums.

This year's study also examined stress in the Canadian workplace. The findings highlight what ought to be an area of great concern for plan sponsors. Roughly half of the plan members surveyed report experiencing "a great deal of stress" on the job. And more than one in 10 are taking time off work because of stress.

THE PUBLIC SYSTEM

Eighty-one per cent of plan members surveyed describe Canada's healthcare system as either "excellent," "very good" or "good." That percentage has remained essentially static in the three years that Aventis Pharma has conducted this study. There has, however, been an increase in the number of plan members describing the system in negative terms. This year 19% call the system "poor" or "very poor." That's up from 14% who said so in 1999 and 6% in 1998.

Despite the relatively positive view, an increasing number of plan members say the Canadian system is in decline. Seventy-one per cent of survey respondents say it has "worsened in the last couple of years." Just 4% believe the healthcare system has "improved," and 24% say it has "stayed the same."

Plan members aged 55 and older are more likely to view the system in a negative light, according to this year's findings. Twenty-five per cent of respondents in that demographic describe the system as "poor" or "very poor." That compares to 19% of plan members between 35 and 54 and 13% of members between 18 and 34 who say the same.

Seventy-nine per cent of plan members 55 and older say the system has "worsened in the last couple of years." Seventy-six per cent of survey participants between 35 and 54, and 61% of plan members between 18 and 34, describe the same decline.

EMPLOYER-SPONSORED PLANS

The word on employer-sponsored benefits plans is more positive. Of plan members surveyed, 68% say their plan at work meets their needs "very well" or "extremely well" (see "Meeting needs," right). This number is down from 1999's report, when 73% of plan members described their employer-sponsored plans in those positive terms, but it is up from the 1998 findings--64% said the same that year.

Only 4% of plan members report dissatisfaction with their employer-sponsored plans.

The more plan members earn, the more they appear satisfied with their benefits plan. Among survey participants earning $60,000 or more annually, 72% say their plan meets their needs "very well" or "extremely well." That percentage drops to 67% of respondents earning between $30,000 and $60,000 a year, and to 62% of plan members earning less than $30,000 a year.

Respondents were asked about which aspects of their benefits plan they value most. Drug coverage is the clear winner--94% of plan members say their drug plan is either "very important" or "somewhat important".

Short-term and long-term disability coverage ranks a close second among the plan members surveyed. Ninety-two per cent describe these as "very important" or "somewhat important." Eighty-eight per cent say the same about both dental plans and extended health benefits, 81% say so about accidental death and dismemberment and 80% say so about life insurance.

DRUG PLAN COSTS

Not surprisingly, given that such a high number of plan members rank drug coverage as important, a solid majority believe that cost should not be a factor in an employer's decision to cover a new drug. Eighty per cent say it is important that "employee health plans cover any new drugs that are available regardless of their cost." Just 4% of respondents disagree that this is an important point, and 17% are neutral on the issue.

Still, a good number of plan members understand how expensive new drugs can be, and they're prepared to pay a share. Of plan members surveyed, 75% are either "very willing" or "somewhat willing" to pay for the coverage of new drugs, if and when their employer isn't. That percentage breaks down this way: 46% are "somewhat willing" and 29% are "very willing."

Fifteen per cent are "somewhat unwilling" and 9% are "very unwilling" to pay a higher premium to guarantee coverage.

On the question of how much plan members are prepared to pay, the survey provided a choice of ranges. The greatest number--38% of respondents--say they would pay between $100 and $250 per year more than they already are to guarantee receiving the best therapy possible. Eighteen per cent of respondents say they would pay more than $250, 17% would pay up to $100 and 10% say they would pay nothing more than they already are.

Income, of course, plays a role in these numbers--particularly on the breakdown of those plan members prepared to pay over $250 more a year. Twenty-two per cent of respondents earning over $60,000 a year say they would pay that much extra, 18% of plan members earning between $30,000 and $60,000 annually are willing to pay that much, and of plan members earning less than $30,000 just 11% would.

THE STRESS FACTOR

Almost half of the plan members surveyed report experiencing "a great deal of stress" at work. Forty-seven per cent say so, based on the study's description of stress as "your body's negative response to challenges in your life at both work and home." "The good news is that the other half feels that they're not as stressed," says Sharma.

How is this stress effecting plan members? Sixty-four per cent of respondents "feel irritable or anxious." Forty-two per cent say they "lose sleep" because of stress. Twenty-one per cent "get sick more often" as a result of stress. And 11% report that they "book more time off from work."

That's not all: 11% experience "irritability" and have "less patience/anger;" 9% point to "fatigue/burn-out;" and 7% say stress causes "anxiety/worry/nervousness" and has a "negative effect on my relationships."

Workload is the most common source of this stress. Forty-three per cent of respondents say it causes them stress. Interestingly, men and women differ on this point somewhat--47% of female plan members say workload stresses them out, while just 39% of men say so.

Higher income earners also report an above-average rate of workload stress. Among plan members earning $60,000 or more a year, 51% say workload is a source of stress. Meanwhile, 41% of plan members earning between $30,000 and $60,000 annually, and just 26% of respondents with a salary of less than $30,000 a year, say the same.

The next most common source of stress is a result of trying to meet personal financial responsibilities. That is identified by 35% of plan members surveyed. Third highest is balancing work with home or personal life--32% of respondents say that causes stress. Job insecurity ranks fourth highest as a cause of stress. Twenty-three per cent say that is stressful.

Are plan sponsors doing enough to help members manage stress at work? Not according to 41% of those plan members surveyed. Among unionized plan members, the percentage who say no is higher--47% say their employers aren't doing enough (compared to 37% of non-union members who say so). A breakdown of plan members by public/private sector shows similar results--47% of public sector workers say their employers aren't doing enough while 36% of private sector members say the same.

Clearly, there are concerns about the state of healthcare in Canada. Generally, plan members are positive in their view of what employers are doing for them. Those efforts are particularly important at a time when Canadians' faith in the public system is in decline. Still, there are challenges ahead for plan sponsors. Stress is a good example. So is drug plan coverage. Plan members have a positive view of their employers' efforts on this latter point. And the firmness of their views on continued drug coverage suggests a clear priority for plan sponsors and the healthcare industry at large.

Plan members recognize that the rising cost of healthcare is a critical issue. Who do they think should pay?

Most Canadian plan members believe the public healthcare system should be funded by a combination of taxes and user fees. Fifty-five per cent of participants in Aventis Pharma's third Canadian Consumer Survey on Healthcare say so. That percentage is consistent with previous year's findings.

Survey respondents were also asked who they expect to pay for medical services de-listed by provincial health plans. Note that the question posed was who plan members "expect" will pay, not who they think should pay. Forty per cent, the same percentage as in 1999's study, expect individuals will pay for the de-listed services themselves (see "Covering de-listed services," page 77). The rest breaks down as follows: 38% expect employers to pay for these services (up from 31% in 1999); 12% expect it will be a combination of individuals and employers (down from 17% in 1999); 5% expect a combination of federal and provincial governments to pay (down from 6% last year); and 1% expect it will be private insurance (down from 3% in 1999).

Of unionized plan members surveyed, 43% expect employers will cover these costs, 32% expect individual plan members to pay and 14% expect it will be a combination of both. Among non-unionized members, 38% expect it will be employers, 43% expect employees and 11% expect a combination.

An above-average percentage of younger plan members are counting on employers here. Of plan members aged 18 to 34, 47% expect employers will pay for de-listed services, 35% expect individuals will and 9% expect a combination of the two. Among members aged 35 to 54, 40% expect employers, 39% expect individuals and 12% expect a combination. And of plan members aged 55 and older, 29% expect employers, 40% expect individuals and 18% expect a combination to pay.

The percentage of plan members who say their employer-sponsored plan meets their needs "very well" or "extremely well" is down this year.

Four out of 10 Canadian plan members believe they will have to pay for de-listed healthcare services themselves. An almost equal number are counting on employers.

Drug plans are clearly most important to plan members. More than seven out of 10 describe drug coverage as "very important."

Most plan members believe their employer is doing a good job communicating the benefits plan. But they're worried about confidentiality.

The state of plan sponsor communications in Canada is good, but there is concern among many plan members about high tech communications and what impact those might have on the confidentiality of their personal health records.

First the good news: 32% of plan members surveyed say their employer does a "very good job" and 40% of members say their employer does a "good job" of "communicating information about what is and is not covered by [their] employee health benefits plan." Only 18% say their employer does either a "poor job" or a "very poor job."

What communications media do members prefer? A toll-free information line ranks first--72% say that would be beneficial. Sixty-seven per cent say they would like easier access to a knowledgeable person in the company, 45% want information posted on the Internet, 44% would like more frequent newsletters and 43% want meetings and seminars.

Plan sponsors using online media should be aware of the confidentiality concerns some plan members have. In this year's study, 55% of respondents say they worry about inappropriate access to confidential information and 50% believe that tampering and inaccuracies are a possibility online.

"Either we have not done enough to secure our systems, or we have not done enough in communicating to plan members that our systems are secure," says Sanjiv Sharma, director, health policy, strategic planning at Aventis Pharma.

Their concern does not just involve third parties either. Fifty-six per cent of plan members surveyed either "strongly agree" or "somewhat agree" that their employer "has no right to know anything about [their] personal health condition."

Compare that statistic to the responses of plan members to this scenario: "In order to offer employees an appropriate range of educational health programs, it is important for companies to assess the health needs of its employees. To do this, employers would typically hire independent healthcare consultants to assist employees in filling out a confidential personal health questionnaire. Based on the data gathered in these questionnaires, the healthcare consultants would then determine if employees are at particular risk for certain diseases such as diabetes or cancer and then develop educational health programs accordingly."

Sixty-eight per cent of plan members say they would provide confidential health information in that kind of situation--34% say they would be "very willing" and 34% say they would be "somewhat willing." But the employer's role is a factor. Of those who are less than "very willing," 52% say they are more likely to provide confidential health information if told that "their employer would never have access to their personal health records." But even after that promise, 47% are still unwilling to provide confidential information.

The Romanow Commission has released its final report on the future of healthcare in Canada.

For Commissioner Romanow's recommendations, click here.

Click here for Senator Michael Kirby's report, "The Health of Canadians – The Federal Role: Recommendations for Reform."