Health Services Access Survey (HSAS)
Detailed information for 2001
The objective of the survey was to provide information on the experiences of respondents in using some selected health care services. The survey focused on two main topics: waiting for specialized services for a new illness or condition and access to basic health care.
Data release - July 15, 2002
- Questionnaire(s) and reporting guide(s)
- Data sources and methodology
- Data accuracy
This survey became part of the Canadian Community Health Survey (number 3226) in 2003.
Following the September 2000 First Ministers' Health Accord, it was agreed that federal, provincial and territorial governments would report to their constituents on the results and performance of the health care systems starting in September 2002. These reports would contain measures for 14 health indicator areas. Within the quality of service, there were two measures for which data were not available: a) waiting time for key diagnostic and treatment service and b) access to 24/7 first contact health services. The Health Services Access Survey was designed to collect this information including patient experiences, acceptance and perceptions of waiting for care.
The content of the survey, while not expected to address perfectly the information need on these two indicator areas, sheds considerable light on Canadians' experiences and perceptions regarding access to health care services.
The objective of the survey was to provide information on the experiences of respondents in two major areas: 24/7 access to first contact services and access to specialized services including waiting times.
Information on 24/7 access to first contact services includes:
- experience of respondents in getting health information or advice;
- experience of respondents in getting health care services for routine or on-going care;
- experience of respondents in getting immediate care for minor heath problems such as fever, headache; sprained ankle, vomiting or unexplained rash, etc.
- experience of respondents in getting health care services in general.
Respondents were asked about their use of first contact services at different times of the day, difficulties accessing services, and where services were obtained.
Information on access to specialized services includes:
- experience of respondents requiring care from a medical specialist such as a cardiologist, allergist, etc. to obtain a diagnostic for a new illness or condition;
- experience of respondents requiring non-emergency surgery such as cardiac surgery, joint surgery, etc.;
- experience of respondents requiring selected diagnostic tests: MRIs, CAT scans and angiographies.
Respondents were asked about their experiences accessing these services including waiting times, acceptability of the waiting time and impact of the wait on the respondent.
Reference period: Varies according to the question (for example: "over the last 12 months", "over the last 6 months", "during the last week", etc.)
Collection period: November and December 2001
- Health and disability among seniors
- Health care services
- Older adults and population aging (formerly Seniors)
Data sources and methodology
The HSAS targets persons aged 15 years or older who are living in private dwellings. Persons living on Indian Reserves or Crown lands, residents of institutions, full-time members of the Canadian Armed Forces and residents of the three Territories are excluded from this survey.
Each CCHS cycle questionnaire has been conceived in collaboration with specialists from Statistics Canada, other departments and/or academic fields. The CCHS questions were designed for computer-assisted interviewing (CAI), meaning that, as the questions were developed, the associated logical flow into and out of the questions was programmed. This included specifying the type of answer required, the minimum and maximum values, on-line edits associated with the question and what to do in case of item non-response.
With CAI, the interview can be controlled based on answers provided by the respondent. On-screen prompts are shown when an invalid entry is recorded and thus immediate feedback is given to the respondent and/or the interviewer to correct inconsistencies. Another enhancement is the automatic insertion of reference periods based on current dates. Pre-filling of text or data based on information gathered during the interview allows the interviewer to proceed without having to search back for previous answers. This type of pre-fill includes such things as using the correct name or sex within the questions themselves. Allowable ranges/answers based on data collected during the interview can also be programmed. In other words, the questionnaire can be customized to the respondent based on data collected at that time or during a previous interview.
This is a sample survey with a cross-sectional design.
The Health Services Access Survey was administered in November and December 2001 to a sub-sample of the respondents to the Canadian Communities Health Survey (CCHS) sample.
The CCHS uses a combination of two sampling frames to select their sample. The first is the same frame used by the Canadian Labour Force Survey (LFS). This survey design is a stratified, multistage design employing probability sampling at all stages. In regions where the LFS frame could not supply a sufficient sample size for the CCHS, a Random Digit Dialling (RDD) method was used to supplement the area frame sample. Within each selected household, either one or two people aged 12 and over were selected. The number depended upon the household composition and was intended to increase the representation of two age groups of interest - youths (aged 12-19) and seniors (age 65+). For more details on the CCHS sample design, click here.
A sub-sample of CCHS respondents were selected to receive the HSAS. The sample size varied from one province to the next, depending upon the size of the province and whether the provincial ministry of health decided to supplement the collection of extra sample. In order for a CCHS respondent to be eligible to be selected for the HSAS he/she had to meet the following criteria:
i) The individual had to be at least fifteen years old as of November 1, 2001.
ii) The individual had to have agreed to share his/her CCHS data with the provincial partners during the CCHS interview.
iii) The individual had to have provided Statistics Canada with a telephone number at which he/she could be contacted.
iv) No sample was selected from the three territories.
In addition to the above requirements, there were other restrictions. Only one person per household could be selected (in some cases CCHS had selected two). Households that were selected for September or October 2000 CCHS collection were ineligible to receive the HSAS (October respondents in PEI were the exception to this rule). Finally, people who were chosen for the CCHS via the Random Digit Dialling frame were not eligible to be selected, with the exception of those households chosen from five health regions where no CCHS sample had been selected from the LFS frame. Once the sampling frame and sample size were finalized, the HSAS sample was selected by using a systematic sampling method from the frame sorted by a geographic identifier. This allowed all regions of a province to be covered by the HSAS.
Sample size by province
Newfoundland and Labrador: 1,000
Prince Edward Island: 1,259
Nova Scotia: 1,000
New Brunswick: 1,000
British Columbia: 4,839
For information on the Health Services Access Survey 2003, please refer to its description under the Documentation section.
Data collection for this reference period: November 19, 2001 to December 28, 2001
Responding to this survey is voluntary.
Data are collected directly from survey respondents.
Data collection for the HSAS was carried out between November 19 and December 28, 2001. Statistics Canada interviewers are employees hired and trained specifically to conduct Computer Assisted Personal Interviews for the Labour Force Survey and other major surveys such as the CCHS. The interviews for the Health Services Access Survey were conducted by telephone with the selected respondent. Interviewer training consisted of reading the Health Services Access Interviewers' Manual, practicing with the training cases on the laptop computer, and discussing any questions with senior interviewers before the start of the survey. A description of the background and objectives of the survey was provided, as well as a glossary of terms and a set of questions and answers.
Proxy interviews were not allowed for the HSAS. In total, 17,616 individuals were eligible for the Health Services Access Survey. A total of 14,210 of these individuals either responded or were found to no longer be in our target population (dead or institutionalized) for a response rate of 81%. The overall response rate to the CCHS had been 84.68%. The main output of the HSAS is a "clean" microdata file.
Capture of survey data was accomplished using minicomputers. During this process any document containing at least one interviewer-completed item was captured and an unedited version of the computer record was electronically transmitted to Ottawa for further processing. In total 17,616 documents were captured and transmitted for the survey. The first stage of survey processing undertaken at head office was the replacement of any 'out-of range' values on the data file with blanks. This process was designed to make further editing easier. The first type of error treated was errors in questionnaire flow, where questions which did not apply to the respondent (and should therefore not have been answered) were found to contain answers. In this case a computer edit automatically eliminated superfluous data by following the flow of the questionnaire implied by answers to previous, and in some cases, subsequent questions. The second type of error treated involved a lack of information in questions which should have been answered. For this type of error, a non-response or "not-stated" code was assigned to the item.
A few data items on the questionnaire were recorded by interviewers in an open-ended format. A total of nine partially open-ended questions were included in the survey. These questions related to type of surgery and health conditions. A number of possible answers were provided for each question but giving the possibility to enter a write-in answer if the answer was not included in the list. In some cases, the answer given was recoded to an existing code while in other cases new answer categories were created.
For information on the Health Services Access Survey 2003, please refer to its description under the Documentation section.
View the Questionnaire(s) and reporting guide(s) .
Some editing of the data is performed at the time of the interview by the computer-assisted interviewing (CAI) application. It is not possible for interviewers to enter out-of-range values and flow errors are controlled through programmed skip patterns. For example, CAI ensures that questions that do not apply to a respondent are not asked. In response to some types of inconsistent or unusual reporting, warning messages are invoked but no corrective action is taken at the time of the interview. Where appropriate, edits are instead developed to be performed at Head Office after data collection. Inconsistencies are usually corrected by setting one or both of the variables in question to "not stated".
Several edits are performed at Head Office during the data processing step. A critical error edit is done that rejects respondent entries (for instance, excluded populations). Flow errors are also adjusted during processing and a data inconsistency detection and correction program is applied. Response frequency obtained during the current period and previous reference periods is also compared to identify errors prior to release.
Health indicators originating from the CCHS core content are going through a validation process after final micrododata files are produced. Estimates for all geograhy levels by sex and by age groups are compared to estimates from previous years. This process allows to confirm that estimates of key indicators are acceptable.
There was no imputation performed
The principle behind estimation in a probability sample is that each person in the sample "represents", besides himself or herself, several other persons not in the sample. For example, in a simple random 2% sample of the population, each person in the sample represents 50 persons in the population. In the terminology used here, it can be said that each person has a weight of 50. The weighting phase is a step that calculates, for each person, his or her associated sampling weight. This weight must be used to derive meaningful estimates from the survey. For example, if the number of individuals who had a major depressive episode is to be estimated, the weights of survey respondents having that characteristic should be summed. In order for estimates produced from survey data to be representative of the covered population and not just the sample itself, a user must incorporate the survey weights into their calculations.
In order to determine the quality of an estimate, the variance must be calculated. Because the CCHS uses a multi-stage survey design, there is no simple formula that can be used to calculate variance estimates. Therefore, an approximative method is needed. Coefficient of variation, standard deviation and confidence intervals can then be calculated from the variance. The bootstrap re-sampling method used in the CCHS involves the selection of simple random samples known as replicates, and the calculation of the variation between the estimates from replicate to replicate. In each stratum, a simple random sample of (n-1) of the n clusters is selected with replacement to form a replicate. Note that since the selection is with replacement, a cluster may be chosen more than once. In each replicate, the survey weight for each record in the (n-1) selected clusters is recalculated. These weights are then post-stratified according to demographic information in the same way as the sampling design weights in order to obtain the final bootstrap weights. The entire process (selecting simple random samples, recalculating and post-stratifying weights for each stratum) is repeated B times, where B is large. The CCHS typically uses B=500, to produce 500 bootstrap weights. To obtain the bootstrap variance estimator, the point estimate for each of the B samples must be calculated. The standard deviation of these estimates is the bootstrap variance estimator. Statistics Canada has developed a program that can perform all of these calculations for the user: the Bootvar program.
Consult Userguide in attachment (section 8).
Public Use Microdata Files (PUMFs) are produced in addition to the Master files. The PUMFs differ in a number of important aspects from the survey "master" files held by Statistics Canada. These differences are the result of actions taken to protect the anonymity of individual survey respondents. First, only cross-sectional data are available on such files, because longitudinal information can lead to the identification of respondents. Also, some sensible variables are regrouped, capped or completely deleted from the files. Users requiring access to information excluded from the microdata files may purchase custom tabulations, or access the master files through the Research Data Centres program or the Remote Access program. Outputs are vetted for confidentiality before being given to users.
Before releasing and/or publishing any estimate from these files, users should first determine the number of sampled respondents who contribute to the calculation of the estimate. If this number is less than 30, the weighted estimate should not be released regardless of the value of the coefficient of variation for this estimate. For weighted estimates based on sample sizes of 30 or more, users should determine the coefficient of variation of the rounded estimate and follow the guidelines below.
Estimates in the main body of a statistical table are rounded to the nearest hundred units using the normal rounding technique. If the first or only digit dropped is zero to four, the last digit retained is not changed. If the first or only digit dropped is five to nine, the last digit retained is raised by one. Marginal sub-totals and totals in statistical tables are derived from their corresponding unrounded components and then are rounded themselves to the nearest 100 units using normal rounding methods. Averages, proportions, rates and percentages are computed from unrounded components (for example, numerators and/or denominators) and then are rounded themselves to one decimal using normal rounding. In normal rounding to a single digit, if the final or only digit dropped is zero to four, the last digit retained is not changed. If the first or only digit dropped is five to nine, the last digit retained is increased by one. Sums and differences of aggregates (or ratios) are derived from their corresponding unrounded components and then are rounded themselves to the nearest 100 units (or the nearest one decimal) using normal rounding. Under no circumstances are unrounded estimates, published or otherwise, released. Unrounded estimates imply greater precision than actually exists.
Revisions and seasonal adjustment
This methodology does not apply to this survey.
Consult the Userguide.
- Health Services Access Survey - User Guide
- Health Services Access Survey - Data Dictionary