The Fraser Institute 1999 (Mar); Vancouver, BC
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Ramsay C, Walker M, Alexander J
Background : In recent years, there have been numerous reports on the use of alternative therapies in Canada, but there has been little research conducted on the reasons people are using these therapies, no estimates of how much people are spending out-of-pocket on these therapies, and no recommendations drafted on how alternative therapies should be addressed by public policy. The Fraser Institute, employing a methodology similar to that used by the Center for Alternative Medicine Research in a ground breaking study on alternative medicine use in the United States in 1991,1 conducted a Canadian national survey to determine the prevalence, costs, and patterns of alternative medicine use, such as chiropractic, naturopathic, and herbal therapies. We questioned respondents on their attitudes towards both conventional and alternative health care to gauge public demand for policy action in these areas. As well, we surveyed respondents’ attitudes about various ways of funding health care, and where they felt the responsibility for making health care funding and resource allocation decisions should lie.
A total of 1,500 interviews with a randomly-selected sample of Canadian adults 18 years of age or older were conducted in May and June of 1997. The response rate was 25.7 percent. Respondents were asked to report any health conditions, details of their use of conventional medical services in treating their conditions, and whether they had tried any alternative therapies as treatment for these conditions. With respect to alternative medicine use, respondents were asked to indicate whether they had used any of 22 commonly used therapies that are neither widely taught in North American medical schools nor generally available in North American hospitals. Lastly, we also asked respondents several questions about their attitudes towards health, health care, medical care, and public policy.
As well, because of the low response rate, 150 interviews were completed with randomly selected non-respondents to the initial survey to test for selection bias. The comparison of the results from the initial survey and the non-respondent survey revealed no significant selection bias in the initial survey.
Results: Most respondents considered themselves to be in good, very good, or excellent health (89 percent in total). Less than one fifth (19%) of respondents reported that their daily activities were limited by health problems. The most common health conditions reported in the 12 months prior to the survey were back or neck problems (30%), allergies (29%), and arthritis or rheumatism (19.5%).
With respect to the use of conventional health care services, most respondents (88%) “usually” seek medical care from a particular doctor’s office, clinic, or health centre, but as their confidence in their doctor decreases, so does their likelihood of being loyal to a particular doctor or clinic. On average, respondents visited a doctor 2.4 times in the 12 months prior to the survey, and almost three-quarters of respondents have either “total confidence” or “a lot of confidence” in their medical doctor. On average, 73 percent of respondents sought medical attention during the prior year for their health, and almost eight in ten of these people found the medical care they received to be very or somewhat helpful.
Almost three-quarters of respondents (73%) had used at least one alternative therapy sometime in their lives. Chiropractic was the most common form of alternative medicine used (36%), followed by relaxation techniques and massage (both 23%), and prayer (21%). Fifty percent of respondents reported using at least one alternative therapy in the previous 12 months, with prayer (18%), relaxation (17%), and chiropractic (13%) being the most popular. Canadians used alternative therapies an average of 4.4 times in the 12 months prior to the survey, most often to prevent future illness from occurring, or to maintain health and vitality (81% in total). Approximately 88% of alternative therapy users found the medical care they received to be either “very” or “somewhat” helpful. Of those who used alternative medicine in the 12 months prior, 44.3% discussed doing so with their doctor.
The average amount paid out-of-pocket per user to an alternative health care provider in the year prior to the survey was $60. The average amounts, by alternative specialty, ranged from $23 for osteopathy to $1,381 for imagery techniques. Extrapolation for the Canadian population suggests that in 1997 Canadians spent more than $1.8 billion out-of-pocket on visits to providers of alternative medicine. If the additional money spent on books, medical equipment, herbs, vitamins, and special diet programs is included, the estimated total out-of-pocket spending on alternative medicine in Canada increases to more than $3.8 billion in 1997.
Despite the large out-of-pocket expenses that Canadians are incurring for alternative medicine, a majority believe that it should be covered privately (60.3%) and not be included in provincial health plans. With respect to what is covered by provincial insurance, 37 percent of respondents felt that these decisions should be made by all health care providers—alternative and conventional. Rarely was the appropriate decision maker seen to be the provincial government (13%), the federal government (9%), the regional health authorities (9%), or the general public (2%).
Conclusions: The majority of Canadians have used some form of alternative medicine. They are spending a large amount of their own money on these therapies, most of which are only partially covered by provincial health insurance plans. However, most Canadians still rely heavily on conventional medical treatment and do not support paying for alternative therapies through provincial health care plans. Canadians seem to realize that the current health system is under pressure and will not be able to fund every type of health care treatment that is available. Policy makers should take heart from this. At the same time, most Canadians feel that health professionals, more than governments, should decide what is provincially insured.