Survey on Health Care Access and Experiences - Primary and Specialist Care

For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

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Household members and geographic region (DEM)
Geographic region (DHH)
Household information (HHC)
Age Order Selected Respondent (AOSR)
Age (AGE)
Sex and gender (GDR)
Main activity (MAC)
General health (GEN)
Life satisfaction (LSM)
Chronic conditions (CHR)
Disability (DIS)
Primary health care (PHC)
Primary health care use (HC1)
Patient Experience (PEX)
Primary health care - difficulties in the past 12 months (HC2)
Specialist care (HC3)
Specialist care - difficulties in the past 12 months (HC4)
Care coordination (CCO)
Health care barriers (HCB)
Unmet health care needs (UCN)
Prescription cost (PCN)
Insurance coverage (INP)
Out-of-pocket expenses (XOPE)
Indigenous identity (ABM)
Population group (PG)
Place of birth, immigration and citizenship (DEM1)
Language (LAN)
Sexual orientation (SOR)
Education (ED)
Administrative information (ADM1)
Health Number (HN)
Administrative information - Share agreements (ADM2)

Household members and geographic region (DEM)

Household members and geographic region (DEM) - Question identifier:DEM_Q05A

What is your first and last name?
First name

Long Answer Length = 80

Household members and geographic region (DEM) - Question identifier:DEM_Q05B

What is your first and last name?
Last name

Long Answer Length = 80

Geographic region (DHH)

Geographic region (DHH) - Question identifier:DHH_Q05

To determine which geographic region you live in, please provide your postal code.

Long Answer Length = 80

Geographic region (DHH) - Question identifier:DHH_Q10

In which province or territory do you currently live?

10: Newfoundland and Labrador
11: Prince Edward Island
12: Nova Scotia
13: New Brunswick
24: Quebec
35: Ontario
46: Manitoba
47: Saskatchewan
48: Alberta
59: British Columbia
60: Yukon
61: Northwest Territories
62: Nunavut

Household information (HHC)

Household information (HHC) - Question identifier:HHC_Q05

Including [yourself], how many people live in your household?

01: 1
02: 2
03: 3
04: 4
05: 5
06: 6
07: 7
08: 8
09: 9
10: 10
11: 11
12: 12
13: 13
14: 14
15: 15
16: 16
17: 17
18: 18
19: 19
20: 20 or more

Household information (HHC) - Question identifier:HHC_Q10

Including [yourself], how many people [18] years of age or older live in your household?

01: 0
02: 1
03: 2
04: 3
05: 4
06: 5
07: 6
08: 7
09: 8
10: 9
11: 10
12: 11
13: 12
14: 13
15: 14
16: 15
17: 16
18: 17
19: 18
20: 19
21: 20 or more

Age Order Selected Respondent (AOSR)

Age Order Selected Respondent (AOSR) - Question identifier:AOSR_Q05

Among the [number of] people aged [18] or more living in your household, which are you?

1: The oldest
2: [The youngest] / [The second oldest]
3: [The third oldest (youngest)]
4: [The fourth oldest (youngest)]
5: [The fifth oldest (youngest)]
6: [The sixth oldest (youngest)]

Age Order Selected Respondent (AOSR) - Question identifier:AOSR_Q10

The [selected person] has been selected to participate in this survey. Is this person currently available to continue with this survey?

1: Yes (Have the [selected person] continue now)
2: No, the [selected person] is not available at this time
3: No, the [selected person] is unable to answer because of a health condition, a physical or mental disability, or problems related to aging

Age Order Selected Respondent (AOSR) - Question identifier:AOSR_R15

When the [selected person] becomes available to participate in this survey, they can do so by following the instructions in the letter you have received.

You may now exit the survey by clicking on Log out located at the top right of this page.

Age Order Selected Respondent (AOSR) - Question identifier:AOSR_R16

Thank you for your time. You may be contacted by a Statistics Canada interviewer at a later time.

You may now exit the survey by clicking on the Log out button at the top right of this page.

Age Order Selected Respondent (AOSR) - Question identifier:AOSR_Q20A

Provide your first and last name.

Note: This question refers to the [selected person], who has been selected to continue this questionnaire.
First Name

Long Answer Length = 50

Age Order Selected Respondent (AOSR) - Question identifier:AOSR_Q20B

Provide your first and last name.

Note: This question refers to the [selected person], who has been selected to continue this questionnaire.
Last Name

Long Answer Length = 50

Age (AGE)

Age (AGE) - Question identifier:AGE_Q01A

What is your date of birth?

Min = 0000; Max = 9999

Age (AGE) - Question identifier:AGE_Q01B

What is your date of birth?

01: January
02: February
03: March
04: April
05: May
06: June
07: July
08: August
09: September
10: October
11: November
12: December

Age (AGE) - Question identifier:AGE_Q01C

What is your date of birth?

01: 1
02: 2
03: 3
04: 4
05: 5
06: 6
07: 7
08: 8
09: 9
10: 10
11: 11
12: 12
13: 13
14: 14
15: 15
16: 16
17: 17
18: 18
19: 19
20: 20
21: 21
22: 22
23: 23
24: 24
25: 25
26: 26
27: 27
28: 28
29: 29
30: 30
31: 31

Age (AGE) - Question identifier:AGE_Q02

What is your age?

Min = 0; Max = 999

Sex and gender (GDR)

Sex and gender (GDR) - Question identifier:GDR_R05

The following questions are about sex at birth and gender.

Sex and gender (GDR) - Question identifier:GDR_Q05

What was your sex at birth?

1: Male
2: Female

Sex and gender (GDR) - Question identifier:GDR_Q10

What is your gender?

1: Male
2: Female
3: Or please specify

Sex and gender (GDR) - Question identifier:GDR_R15

Please verify that all of the information is correct.

Your information

Sex assigned at birth: [Male/Female/Information not provided]

Gender: [Male/Female/GDR_S10/Information not provided]

Main activity (MAC)

Main activity (MAC) - Question identifier:MAC_R01

The following question concerns your activities during the past 12 months.

Main activity (MAC) - Question identifier:MAC_Q01

During the past 12 months, was your main activity working at a job or business, looking for paid work, going to school, caring for children, household work, retired or something else?

01: Working at a job or business
02: Looking for paid work
03: Going to school
04: Caring for your children
05: Household work
06: Retired
07: Maternity, paternity or parental leave
08: Long term illness
09: Volunteering or care-giving other than for your children
10: Other

General health (GEN)

General health (GEN) - Question identifier:GEN_R01

The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

General health (GEN) - Question identifier:GEN_Q01

In general, how is your health?

1: Excellent
2: Very good
3: Good
4: Fair
5: Poor

General health (GEN) - Question identifier:GEN_Q05

In general, how is your mental health?

1: Excellent
2: Very good
3: Good
4: Fair
5: Poor

General health (GEN) - Question identifier:GEN_Q10

Thinking about the amount of stress in your life, how would you describe most of your days?

1: Not at all stressful
2: Not very stressful
3: A bit stressful
4: Quite a bit stressful
5: Extremely stressful

Life satisfaction (LSM)

Life satisfaction (LSM) - Question identifier:LSM_Q01

Using a scale of 0 to 10, where 0 means "Very dissatisfied" and 10 means "Very satisfied", how do you feel about your life as a whole right now?

00: 0 - Very dissatisfied
01: 1
02: 2
03: 3
04: 4
05: 5
06: 6
07: 7
08: 8
09: 9
10: 10 - Very satisfied

Chronic conditions (CHR)

Chronic conditions (CHR) - Question identifier:CHR_R05

The next question is about long-term health conditions. These are conditions which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.

Chronic conditions (CHR) - Question identifier:CHR_Q05

Have you been diagnosed by a health professional with any of the following long-term health conditions?

01: Asthma
02: Chronic lung condition (e.g., emphysema, bronchitis, chronic obstructive pulmonary disease (COPD))
03: Chronic heart disease
04: Diabetes (Exclude gestational diabetes.)
05: Chronic kidney disease
06: Liver disease (e.g., chronic hepatitis)
07: High blood pressure
08: Chronic blood disorder (e.g., sickle cell anemia, hemophilia)
09: A weakened immune system (e.g., due to disease or medication)
10: Chronic neurological disorder (e.g., amyotrophic lateral sclerosis (ALS) or Lou Gehrig's disease, multiple sclerosis (MS), Parkinson's disease)
11: Effects of a stroke
12: Alzheimer's disease or other dementia
13: Cancer
14: Arthritis (e.g., osteoarthritis, rheumatoid arthritis, gout
Exclude fibromyalgia.)
15: Eye disease (e.g., glaucoma, cataracts, macular degeneration, retinopathy)
16: Urinary incontinence
17: Bowel disorder (e.g., Crohn's disease, ulcerative colitis, irritable bowel syndrome, bowel incontinence)
18: Mood disorder (e.g., depression, bipolar disorder, mania or dysthymia)
19: Anxiety disorder (e.g., phobia, obsessive-compulsive disorder (OCD) or a panic disorder)
20: Post-traumatic stress disorder (PTSD)
21: Other
22: None of the above

Disability (DIS)

Disability (DIS) - Question identifier:DIS_Q05

Do you identify as a person with a disability?

1: Yes
2: No

Primary health care (PHC)

Primary health care (PHC) - Question identifier:PHC_R05

The next questions are about your primary health care. It is often the first point of entry to the Canadian health care system. It incorporates routine care, diagnosis, treatment and management of health problems, as well as health promotion and disease prevention.

Primary health care (PHC) - Question identifier:PHC_Q05

Do you have a regular health care provider? By this, we mean one health professional that you regularly consult with when you need care or advice for your health.

1: Yes
2: No

Primary health care (PHC) - Question identifier:PHC_Q10

Why do you not have a regular health care provider?

01: Currently on a waitlist
02: Do not need one in particular
03: No one in the area is taking new patients
04: There are no health care providers in the area
05: You have not tried to find one
06: Had one who left, retired, or changed their practice
07: You moved to a new area
08: Transitioned from pediatric to adult care
09: Other

Primary health care (PHC) - Question identifier:PHC_Q15

How long have you been without a regular health care provider?

1: Less than one year
2: 1 year to less than 5 years
3: 5 years to less than 10 years
4: 10 years or more
5: You have never had a regular health care provider

Primary health care (PHC) - Question identifier:PHC_Q20

Is there a place you usually [go] when you require non-urgent primary health care or advice about your health?

1: Yes
2: No

Primary health care (PHC) - Question identifier:PHC_Q25

What type of place is this?

1: A walk-in clinic (Include walk-in clinics, even if you have an appointment.)
2: A community health centre [or CLSC] (Include nursing stations.)
3: A hospital outpatient clinic
4: A hospital emergency room
5: A telephone health line (e.g., Health Links, Health Connect Ontario, Health811, Health-Line, TeleCare, Info-Santé)
6: A pharmacy (Exclude visits that did not involve a consultation.)
7: Other

Primary health care (PHC) - Question identifier:PHC_Q30

Which of the following best describes your regular health care provider?

1: Family doctor or general practitioner
2: Medical specialist (A medical specialist is a medical doctor certified to practice in a specified field.
e.g., dermatologist, cardiologist, oncologist, radiologist, psychiatrist, gynecologist
Exclude optometrists, dentists, pharmacists, family doctors and general pract.)
3: Nurse practitioner (Nurse practitioners are registered nurses with additional training. They can order tests, prescribe medications, and refer to specialists. They can also diagnose and help prevent and manage new illness and chronic disease.)
4: Other health professional (e.g., physiotherapist, psychologist, dietitian, pharmacist)
9: DK

Primary health care (PHC) - Question identifier:PHC_Q35

What kind of place does your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider] work in?

1: An office with one doctor or nurse practitioner working in a solo practice
2: An office with several doctors or nurse practitioners working independently of each other, who may share one or more receptionists or nurses
3: An office with several health professionals working together as a team, that may include doctors, nurse practitioners, nurses, social workers or psychologists
4: Other
9: DK

Primary health care (PHC) - Question identifier:PHC_Q40

When you contact your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]'s office during regular practice hours with a medical concern or question, not related to appointments, how often do you get an answer from someone that same day?

1: Always
2: Often
3: Sometimes
4: Rarely
5: Never
6: Have not tried to contact your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider] other than to make appointments

Primary health care (PHC) - Question identifier:PHC_Q45

When you have a non-urgent primary health care need or require advice about your health, how long do you usually have to wait before you can consult your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]?

01: On the same day
02: The next day
03: 2 to 3 days
04: 4 to 6 days
05: 1 week to less than 2 weeks
06: 2 weeks to less than 1 month
07: 1 month to less than 3 months
08: 3 months to less than 6 months
09: 6 months or more

Primary health care (PHC) - Question identifier:PHC_Q50

Do you usually speak in English, in French or in another language with your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]?

1: English
2: French
3: English and French
4: English and another language
5: French and another language
6: Another language

Primary health care (PHC) - Question identifier:PHC_Q55

Is this the language you would like to speak with your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]?

1: Yes
2: No

Primary health care (PHC) - Question identifier:PHC_Q60

What language would you like to speak with your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]?

1: English
2: French
3: English and French
4: English and another language
5: French and another language
6: Another language

Primary health care (PHC) - Question identifier:PHC_Q65

You said your regular health care provider is [an/a] [medical specialist/other health professional/regular health care provider]. Do you have a family doctor, general practitioner, or nurse practitioner?

1: Yes, a family doctor or general practitioner
2: Yes, a nurse practitioner
3: No

Primary health care use (HC1)

Primary health care use (HC1) - Question identifier:HC1_R05

The following questions are about non-urgent primary health care needs that you may have had in the past 12 months.

Primary health care is often the first point of entry to the Canadian health care system. It incorporates routine care, diagnosis, treatment and management of health problems, as well as health promotion and disease prevention.

Primary health care use (HC1) - Question identifier:HC1_Q05

In the past 12 months, did you consult a health care provider for a non-urgent primary health care need?

1: Yes
2: No

Primary health care use (HC1) - Question identifier:HC1_R10

The next few questions are about the most recent time you consulted a health care provider for a non-urgent primary health care need in the past 12 months.

Primary health care use (HC1) - Question identifier:HC1_Q10

Thinking about the most recent time you needed non-urgent primary health care, did you consult your own [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider], or someone else?

1: Your own [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]
2: Someone else

Primary health care use (HC1) - Question identifier:HC1_Q15

Thinking about the most recent time you needed non-urgent primary health care, which of the following health care providers did you consult?

1: Family doctor or general practitioner
2: Nurse practitioner (Nurse practitioners are registered nurses with additional training. They can order tests, prescribe medications, and refer to specialists. They can also diagnose and help prevent and manage new illness and chronic disease.)
3: Medical specialist (A medical specialist is a medical doctor certified to practice in a specified field.
e.g., dermatologist, cardiologist, oncologist, radiologist, psychiatrist, gynecologist
Exclude optometrists, dentists, pharmacists, family doctors and general pract.)
4: Other health professional (e.g., physiotherapist, psychologist, dietitian, pharmacist)
9: DK

Primary health care use (HC1) - Question identifier:HC1_Q20

Where was [this family doctor or general practitioner/this nurse practitioner/this medical specialist/this other health professional/this health care provider] from?

1: The same office as your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]
2: A different medical office or clinic

Primary health care use (HC1) - Question identifier:HC1_Q25

What type of consultation did you have with [your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]/this nurse practitioner/this medical specialist/this health professional/this health care provider]?

1: In-person
2: Over the telephone (voice only)
3: Video on a phone, tablet or computer
4: Written correspondence (e.g., email, text or instant messaging)

Primary health care use (HC1) - Question identifier:HC1_Q30

How did you consult [your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]/this family doctor or general practitioner/this nurse practitioner/this medical specialist/this health professional/this health care provider]?

1: A walk-in clinic (Include walk-in clinics, even if you have an appointment.)
2: An online clinic
3: A telephone health line (e.g., Health Links, Health Connect Ontario, Health811, Health-Line, TeleCare, Info-Santé)
4: A pharmacy (Exclude visits that did not involve a consultation.)
5: Other
9: DK

Primary health care use (HC1) - Question identifier:HC1_Q35

Still thinking of this most recent time, where did this consultation take place?

1: An office with one or more health care providers
2: A walk-in clinic (Include walk-in clinics, even if you have an appointment.)
3: A community health centre [or CLSC] (Include nursing stations.)
4: A hospital outpatient clinic
5: A hospital emergency room
6: A pharmacy (Exclude visits that did not involve a consultation.)
7: Other

Primary health care use (HC1) - Question identifier:HC1_Q40

Thinking about this most recent time, what was the purpose of this visit?

1: A regular check-up or routine appointment (Include pre-natal care.)
2: Medication or prescription refill
3: Consultation or treatment of a new health concern, illness or injury (e.g., flu, stomach flu or acute stress reaction)
4: Routine care for a chronic condition (A chronic condition usually develops slowly and has lasted or is expected to last six months or more.)
5: Non-routine care for a chronic condition (A chronic condition usually develops slowly and has lasted or is expected to last six months or more.)
6: Referral to a specialist or other health professional
7: Other

Primary health care use (HC1) - Question identifier:HC1_Q40A

Consultation or treatment of a new health concern, illness or injury - Was this:

1: A mental health condition
2: A physical health condition

Primary health care use (HC1) - Question identifier:HC1_Q40B

Routine care for a chronic condition - Was this:

1: A chronic mental health condition
2: A chronic physical health condition

Primary health care use (HC1) - Question identifier:HC1_Q40C

Non-routine care for a chronic condition - Was this:

1: A chronic mental health condition
2: A chronic physical health condition

Primary health care use (HC1) - Question identifier:HC1_Q45

How long did you have to wait between the time you requested care and when you consulted [your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]/this family doctor or general practitioner/this nurse practitioner/this medical specialist/this health professional/this health care provider]?

01: On the same day
02: The next day
03: 2 to 3 days
04: 4 to 6 days
05: 1 week to less than 2 weeks
06: 2 weeks to less than 1 month
07: 1 month to less than 3 months
08: 3 months to less than 6 months
09: 6 months or more

Primary health care use (HC1) - Question identifier:HC1_Q50

How satisfied were you with the wait time?

1: Very satisfied
2: Satisfied
3: Neither satisfied nor dissatisfied
4: Dissatisfied
5: Very dissatisfied

Primary health care use (HC1) - Question identifier:HC1_Q55

Thinking again of this most recent time, to what extent has your life been affected by waiting to consult [your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]/this family doctor or general practitioner/this nurse practitioner/this medical specialist/this health professional/this health care provider]?

1: Extremely affected
2: Very affected
3: Moderately affected
4: Slightly affected
5: Not at all affected

Primary health care use (HC1) - Question identifier:HC1_Q60

How was your life affected as a result of waiting to consult [your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]/this family doctor or general practitioner/this nurse practitioner/this medical specialist/this health professional/this health care provider]?

1: Worry, anxiety, stress
2: Pain
3: Problems with activities of daily living (e.g., dressing, driving)
4: Overall health deteriorated; condition got worse
5: Other

Patient Experience (PEX)

Patient Experience (PEX) - Question identifier:PEX_Q05A

Still thinking about this most recent time you consulted [your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]/this family doctor or general practitioner/this nurse practitioner/this medical specialist/this health professional/this health care provider] for a non-urgent primary health care need, please indicate to what extent you agree or disagree with each statement.
[Your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]/This family doctor or general practitioner/This nurse practitioner/This medical specialist/This health professional/This health care provider] treated you with courtesy and respect

1: Strongly agree
2: Somewhat agree
3: Neither agree nor disagree
4: Somewhat disagree
5: Strongly disagree

Patient Experience (PEX) - Question identifier:PEX_Q05B

1: Strongly agree
2: Somewhat agree
3: Neither agree nor disagree
4: Somewhat disagree
5: Strongly disagree

Patient Experience (PEX) - Question identifier:PEX_Q05C

1: Strongly agree
2: Somewhat agree
3: Neither agree nor disagree
4: Somewhat disagree
5: Strongly disagree

Patient Experience (PEX) - Question identifier:PEX_Q05D

1: Strongly agree
2: Somewhat agree
3: Neither agree nor disagree
4: Somewhat disagree
5: Strongly disagree

Patient Experience (PEX) - Question identifier:PEX_Q05E

1: Strongly agree
2: Somewhat agree
3: Neither agree nor disagree
4: Somewhat disagree
5: Strongly disagree

Patient Experience (PEX) - Question identifier:PEX_Q05F

1: Strongly agree
2: Somewhat agree
3: Neither agree nor disagree
4: Somewhat disagree
5: Strongly disagree

Patient Experience (PEX) - Question identifier:PEX_Q05G

1: Strongly agree
2: Somewhat agree
3: Neither agree nor disagree
4: Somewhat disagree
5: Strongly disagree

Patient Experience (PEX) - Question identifier:PEX_Q05H

1: Strongly agree
2: Somewhat agree
3: Neither agree nor disagree
4: Somewhat disagree
5: Strongly disagree

Patient Experience (PEX) - Question identifier:PEX_Q10

Still thinking about this most recent time, did someone from [your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider]/this family doctor or general practitioner/this nurse practitioner/this medical specialist/this health professional/this health care provider]'s office follow up with you regarding test results?

1: Yes
2: No
3: There were no tests requested

Patient Experience (PEX) - Question identifier:PEX_Q15

Overall, how would you rate the quality of this consultation?

1: Excellent
2: Very good
3: Good
4: Fair
5: Poor

Primary health care - difficulties in the past 12 months (HC2)

Primary health care - difficulties in the past 12 months (HC2) - Question identifier:HC2_R05

The next questions are about your experiences and difficulties accessing the non-urgent primary health care you needed in the past 12 months.

Primary health care - difficulties in the past 12 months (HC2) - Question identifier:HC2_Q05

In the past 12 months, how many times have you consulted a health care provider for a non-urgent primary health care need?

1: Never
2: Once
3: 2 to 4 times
4: 5 to 9 times
5: 10 or more times

Primary health care - difficulties in the past 12 months (HC2) - Question identifier:HC2_Q15

In the past 12 months, did you experience any of the following difficulties getting the non-urgent primary health care you needed?

01: Appointment cancelled or deferred by health care provider
02: Difficulty getting an appointment
03: Waited too long between booking appointment and visit
04: Did not get adequate information or advice
05: Overall health deteriorated; condition got worse
06: Lack of First Nations, Métis or Inuit traditional medicines, healing or wellness practices
07: Lack of availability of culturally appropriate health services
08: Service not available at time required
09: Service not available in the area
10: Service not available in preferred mode (e.g., in-person, virtually)
11: Difficulties related to virtual care technology (e.g., not comfortable with technology, connectivity issues, no access to required tools)
12: Other
13: Did not experience any difficulties getting non-urgent primary health care

Primary health care - difficulties in the past 12 months (HC2) - Question identifier:HC2_Q20

In the past 12 months, did you do any of the following because of difficulties getting the non-urgent primary health care you needed?

01: Seek medical care from a different health care professional or location (Include care from public or private providers located in your province, outside of your province or outside of Canada.)
02: Increase the use of over-the-counter drugs
03: Modify or extend existing medications while waiting for care
04: Increase the use of alcohol or drugs
05: Use traditional medicines
06: Seek medical information through the Internet
07: Seek advice or care from family or friends
08: Other
09: None of the above

Primary health care - difficulties in the past 12 months (HC2) - Question identifier:HC2_Q25

Seek medical care from a different health care professional or location - Was it:

01: An in-person office or clinic other than your regular provider's office
02: A walk-in clinic (Include walk-in clinics, even if you have an appointment.)
03: A virtual-only walk-in or online clinic (Include walk-in clinics, even if you have an appointment.)
04: A community health centre [or CLSC] (Include nursing stations.)
05: A hospital outpatient clinic
06: A hospital emergency room
07: A consultation with a pharmacist
08: A telephone health line (e.g., Health Links, Health Connect Ontario, Health811, Health-Line, TeleCare, Info-Santé)
09: Ambulance or paramedic services
10: Other

Primary health care - difficulties in the past 12 months (HC2) - Question identifier:HC2_Q30

Did you have to pay out-of-pocket for the non-urgent primary health care you sought elsewhere?

1: Yes
2: No

Specialist care (HC3)

Specialist care (HC3) - Question identifier:HC3_R05

The following questions are about specialist care you may have received in the past 12 months.

Specialist care (HC3) - Question identifier:HC3_Q05

During the past 12 months, did you consult a medical specialist for an initial consultation?

1: Yes
2: No

Specialist care (HC3) - Question identifier:HC3_Q10

Thinking of the most recent initial consultation, who referred you to the medical specialist?

1: A family doctor, general practitioner or nurse practitioner
2: Another specialist
3: Another health professional
4: Did not require a referral

Specialist care (HC3) - Question identifier:HC3_Q15

Still thinking of this most recent initial consultation, how did you consult this medical specialist?

1: In-person
2: Over the telephone (voice only)
3: Video on a phone, tablet or computer
4: Written correspondence (e.g., email, text or instant messaging)

Specialist care (HC3) - Question identifier:HC3_Q20

Thinking of your most recent initial consultation, for what type of condition did you consult this medical specialist?

01: Heart condition or stroke
02: Cancer
03: Asthma or other breathing condition
04: Arthritis
05: Cataract or other eye condition
06: Mental health condition
07: Diabetes
08: Skin condition
09: [Urological or gynecological condition]
10: Orthopaedic condition
11: Neurological condition
12: Other

Specialist care (HC3) - Question identifier:HC3_Q25

Thinking of this initial consultation with the medical specialist, how long did you have to wait between the time [you decided to seek care from/you and your health care provider decided that you should see] this medical specialist and when you consulted this medical specialist?

1: Less than 1 month
2: 1 month to less than 3 months
3: 3 months to less than 6 months
4: 6 months to less than a year
5: One year to less than 2 years
6: 2 years or more

Specialist care (HC3) - Question identifier:HC3_Q30

How satisfied were you with the wait time?

1: Very satisfied
2: Satisfied
3: Neither satisfied nor dissatisfied
4: Dissatisfied
5: Very dissatisfied

Specialist care (HC3) - Question identifier:HC3_Q35

To what extent has your life been affected by waiting for this initial consultation?

1: Extremely affected
2: Very affected
3: Moderately affected
4: Slightly affected
5: Not at all affected

Specialist care (HC3) - Question identifier:HC3_Q40

How was your life affected as a result of waiting for this initial consultation?

1: Worry, anxiety, stress
2: Pain
3: Problems with activities of daily living (e.g., dressing, driving)
4: Overall health deteriorated; condition got worse
5: Other

Specialist care - difficulties in the past 12 months (HC4)

Specialist care - difficulties in the past 12 months (HC4) - Question identifier:HC4_R05

The next questions are about your experiences and difficulties accessing the specialist care you needed in the past 12 months.

Specialist care - difficulties in the past 12 months (HC4) - Question identifier:HC4_Q05

In the past 12 months, how many times have you consulted a medical specialist?

1: Never
2: Once
3: 2 to 4 times
4: 5 to 9 times
5: 10 or more times

Specialist care - difficulties in the past 12 months (HC4) - Question identifier:HC4_Q15

In the past 12 months, did you ever experience any of the following difficulties getting the specialist care you needed?

01: Appointment cancelled or deferred by health care provider
02: Difficulty getting an appointment
03: Difficulty getting a referral
04: Waited too long between booking appointment and visit
05: Did not get adequate information or advice
06: Overall health deteriorated; condition got worse
07: Lack of First Nations, Métis or Inuit traditional medicines, healing or wellness practices
08: Lack of availability of culturally appropriate health services
09: Service not available in the area
10: Service not available in preferred mode (e.g., in-person, virtually)
11: Difficulties related to virtual care technology (e.g., not comfortable with technology, connectivity issues, no access to required tools)
12: Other
13: Did not experience any difficulties getting specialist care

Specialist care - difficulties in the past 12 months (HC4) - Question identifier:HC4_Q20

In the past 12 months, did you do any of the following because of difficulties getting the specialist care you needed?

01: Seek medical care from a different health care professional or location (Include care from public or private providers located in your province, outside of your province or outside of Canada.)
02: Increase the use of over-the-counter drugs
03: Modify or extend existing medications while waiting for care
04: Increase the use of alcohol or drugs
05: Use traditional medicines
06: Seek medical information through the Internet
07: Seek advice or care from family or friends
08: Other
09: None of the above

Specialist care - difficulties in the past 12 months (HC4) - Question identifier:HC4_Q25

Seek medical care from a different health care professional or location - Was it:

01: An in-person office or clinic other than your regular provider's office
02: A walk-in clinic (Include walk-in clinics, even if you have an appointment.)
03: A virtual-only walk-in or online clinic (Include walk-in clinics, even if you have an appointment.)
04: A community health centre [or CLSC] (Include nursing stations.)
05: A hospital outpatient clinic
06: A hospital emergency room
07: A consultation with a pharmacist
08: A telephone health line (e.g., Health Links, Health Connect Ontario, Health811, Health-Line, TeleCare, Info-Santé)
09: Ambulance or paramedic services
10: Other

Specialist care - difficulties in the past 12 months (HC4) - Question identifier:HC4_Q30

Did you have to pay out-of-pocket for the specialist care you sought elsewhere?

1: Yes
2: No

Care coordination (CCO)

Care coordination (CCO) - Question identifier:CCO_Q05

In the past 12 months, other than from your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider], did you receive regular health care from any of the following?

1: [Another/A] family doctor or general practitioner
2: [Another/A] nurse practitioner (Nurse practitioners are registered nurses with additional training. They can order tests, prescribe medications, and refer to specialists. They can also diagnose and help prevent and manage new illness and chronic disease.)
3: [Another/A] medical specialist (A medical specialist is a medical doctor certified to practice in a specified field.
e.g., dermatologist, cardiologist, oncologist, radiologist, psychiatrist, gynecologist
Exclude optometrists, dentists, pharmacists, family doctors and general pract.)
4: A nurse
5: Another health professional
6: No other health professional

Care coordination (CCO) - Question identifier:CCO_Q10

In the past 12 months, how would you rate the level of coordination between your [family doctor or general practitioner/medical specialist/nurse practitioner/other health professional/regular health care provider] and other health professionals who provided you care?

1: Excellent
2: Very good
3: Good
4: Fair
5: Poor
6: Not applicable

Care coordination (CCO) - Question identifier:CCO_Q15

To what extent do you feel you need to manage or coordinate your health care between providers?

1: A lot
2: Somewhat
3: A little
4: Not at all
5: Not applicable

Health care barriers (HCB)

Health care barriers (HCB) - Question identifier:HCB_R05

The next question is about your experiences during consultations with health professionals.

Health care barriers (HCB) - Question identifier:HCB_Q05

In the past 12 months, did you feel that you were discriminated against in a health care setting for any of the following reasons?

01: Your Indigenous identity
02: Your race, ethnicity or culture
03: Your gender
04: Your age
05: Your weight
06: Your religion
07: Your language
08: Your sexual orientation
09: A physical disability
10: Something else related to your physical appearance (Include discrimination on the basis of hair style or colour, clothing, jewelry, tattoos and other physical characteristics.
Exclude discrimination on the basis of skin colour or weight.)
11: Your socioeconomic status
12: A mental health condition
13: Your lifestyle (Include smoking, vaping, drug use, alcohol consumption, sedentary activity.)
14: Your beliefs
15: Other
16: Did not experience any of the above

Unmet health care needs (UCN)

Unmet health care needs (UCN) - Question identifier:UCN_R05

The next questions are about your experiences with unmet health care needs.

Unmet health care needs (UCN) - Question identifier:UCN_Q05

During the past 12 months, was there ever a time when you felt that you needed health care, but you did not receive it?

1: Yes
2: No

Unmet health care needs (UCN) - Question identifier:UCN_Q10

During the past 12 months, what type of care did you need but not receive?

01: Treatment of a new physical health condition
02: Treatment of a new mental health condition
03: Routine care for a chronic physical health condition diagnosed by a health professional
04: Non-routine care for a chronic physical health condition diagnosed by a health professional
05: Routine care for a chronic mental health condition diagnosed by a health professional
06: Non-routine care for a chronic mental health condition diagnosed by a health professional
07: A regular check-up (Include pre-natal care.)
08: Care of an injury
09: Medication or prescription refill
10: Other

Unmet health care needs (UCN) - Question identifier:UCN_Q15

What are the reasons why you didn't get the care you needed during the past 12 months?

01: Care not available in the area
02: Care not available at the time required (e.g., doctor busy, away from office or no longer at that practice, inconvenient hours)
03: Do not have a regular health care provider
04: Waiting time too long
05: Appointment was cancelled
06: Felt would receive inadequate care
07: Felt would experience discrimination
08: Cost
09: Language problem
10: Decided not to seek care
11: Doctor didn't think it was necessary
12: Transportation issue
13: Other

Unmet health care needs (UCN) - Question identifier:UCN_Q20

For what reason did you feel you would experience discrimination?

01: Your Indigenous identity
02: Your race, ethnicity or culture
03: Your gender
04: Your age
05: Your weight
06: Your religion
07: Your language
08: Your sexual orientation
09: A physical disability
10: Something else related to your physical appearance (Include discrimination on the basis of hair style or colour, clothing, jewelry, tattoos and other physical characteristics.
Exclude discrimination on the basis of skin colour or weight.)
11: Your socioeconomic status
12: A mental health condition
13: Your lifestyle (Include smoking, vaping, drug use, alcohol consumption, sedentary activity.)
14: Your beliefs
15: Other

Prescription cost (PCN)

Prescription cost (PCN) - Question identifier:PCN_Q05

In the past 12 months, did you have any prescriptions for medication?

1: Yes
2: No

Prescription cost (PCN) - Question identifier:PCN_Q10

In the past 12 months, did you do any of the following because of the cost of your prescription medication?

1: Not fill or collect a prescription medication
2: Skip doses of your medication
3: Reduce the dosage of your medication
4: Delay filling a prescription
5: None of the above

Insurance coverage (INP)

Insurance coverage (INP) - Question identifier:INP_R05

The next question is about your access to health insurance.

Insurance coverage (INP) - Question identifier:INP_Q05

Do you have insurance that covers all or part of the cost of your prescription medications?

1: Yes
2: No
9: DK

Out-of-pocket expenses (XOPE)

Out-of-pocket expenses (XOPE) - Question identifier:XOPE_R05

The next few questions are about any out-of-pocket or direct expenses you may have had because of your health care needs.

Out-of-pocket expenses (XOPE) - Question identifier:XOPE_Q05

In the past 12 months, what was the approximate non-reimbursable out-of-pocket cost for your prescription medications?

1: $0
2: $1 to $249
3: $250 to $499
4: $500 to $749
5: $750 to $999
6: $1000 or more

Out-of-pocket expenses (XOPE) - Question identifier:XOPE_Q10

In the past 12 months, did you have any non-reimbursable out-of-pocket costs for any of the following services?

01: Eye care
02: Dental care
03: Home care
04: Mental health services
05: Rehabilitation therapy (e.g., physiotherapy, occupational, speech or massage therapy)
06: Diagnostic services (e.g., MRI)
07: Surgical services
08: Medical supplies (e.g., ostomy supplies, catheters, needles, CPAP machine)
09: Assistive devices (e.g., mobility aids)
10: None of the above

Indigenous identity (ABM)

Indigenous identity (ABM) - Question identifier:ABM_Q01

Are you First Nations, Métis or Inuk (Inuit)?

1: No, not First Nations, Métis, or Inuk (Inuit)
2: Yes, First Nations (North American Indian)
3: Yes, Métis
4: Yes, Inuk (Inuit)

Indigenous identity (ABM) - Question identifier:ABM_Q02

Are you a Status Indian (Registered or Treaty Indian as defined by the Indian Act of Canada)?

1: No
2: Yes, Status Indian (Registered or Treaty)

Population group (PG)

Population group (PG) - Question identifier:PG_Q05

The following question collects information in accordance with the Employment Equity Act and its Regulations and Guidelines to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.

Are you:

01: White
02: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
03: Chinese
04: Black
05: Filipino
06: Arab
07: Latin American
08: Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
09: West Asian (e.g., Iranian, Afghan)
10: Korean
11: Japanese
12: Other

Place of birth, immigration and citizenship (DEM1)

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30A

Where were you born?

1: Born in Canada
2: Born outside Canada

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30B

Are you a Canadian citizen?

1: Yes, a Canadian citizen by birth
2: Yes, a Canadian citizen by naturalization (Canadian citizen by naturalization refers to an immigrant who was granted citizenship of Canada under the Citizenship Act.)
3: No, not a Canadian citizen

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30C

Are you a landed immigrant or permanent resident?

1: No
2: Yes

Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q35

In what year did you first become a landed immigrant or a permanent resident?

Min = 0; Max = 9999

Language (LAN)

Language (LAN) - Question identifier:LAN_Q01

Can you speak English or French well enough to conduct a conversation?

1: English only
2: French only
3: Both English and French
4: Neither English nor French

Language (LAN) - Question identifier:LAN_Q02

What language do you speak most often at home?

1: English
2: French
3: Other

Language (LAN) - Question identifier:LAN_Q04

What is the language that you first learned at home in childhood and still understand?

1: English
2: French
3: Other

Sexual orientation (SOR)

Sexual orientation (SOR) - Question identifier:SOR_Q01

What is your sexual orientation?

1: Heterosexual (i.e., straight)
2: Lesbian or gay
3: Bisexual or pansexual
4: Or please specify

Education (ED)

Education (ED) - Question identifier:ED_Q05

What is the highest certificate, diploma or degree that you have completed?

1: Less than high school diploma or its equivalent
2: High school diploma or a high school equivalency certificate
3: Trades certificate or diploma
4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
5: University certificate or diploma below the bachelor's level
6: Bachelor's degree (e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.)
7: University certificate, diploma or degree above the bachelor's level

Administrative information (ADM1)

Administrative information (ADM1) - Question identifier:ADM1_R05

To enhance the data from this survey and to minimize the reporting burden for respondents, Statistics Canada will combine your responses with information from the tax data of all members of your household. [Statistics Canada, the provincial ministry of health and the Institut de la statistique du Québec/Statistics Canada and the provincial ministry of health] may also add information from other surveys or administrative sources.

Administrative information (ADM1) - Question identifier:ADM1_Q10

Having a provincial or territorial health number will assist us in linking to this other information. Do you have a provincial or territorial health number?

1: Yes
2: No

Administrative information (ADM1) - Question identifier:ADM1_Q10A

For which province or territory is your health number?

10: Newfoundland and Labrador
11: Prince Edward Island
12: Nova Scotia
13: New Brunswick
24: Quebec
35: Ontario
46: Manitoba
47: Saskatchewan
48: Alberta
59: British Columbia
60: Yukon
61: Northwest Territories
62: Nunavut
88: Does not have a Canadian health number

Health Number (HN)

Health Number (HN) - Question identifier:HN_Q05A

What is your health number?

Long Answer Length = 12

Administrative information - Share agreements (ADM2)

Administrative information - Share agreements (ADM2) - Question identifier:ADM2_R25A

To avoid duplication of surveys, Statistics Canada has signed agreements to share the data from this survey with provincial and territorial ministries of health, Health Canada and the Public Health Agency of Canada. Provincial ministries of health may make the data available to local health authorities.

Data shared with your ministry of health may also include identifiers such as name, address, telephone number and health card number. Health Canada, the Public Health Agency of Canada, and local health authorities, would receive only survey responses and the postal code.

Administrative information - Share agreements (ADM2) - Question identifier:ADM2_R25B

To avoid duplication of surveys, Statistics Canada has signed agreements to share the data from this survey with provincial and territorial ministries of health, the Institut de la statistique du Québec, Health Canada and the Public Health Agency of Canada. The Institut de la statistique du Québec and provincial ministries of health may make this data available to local health authorities.

Data shared with your ministry of health or the Institut de la statistique du Québec may also include identifiers such as name, address, telephone number and health card number. Health Canada, the Public Health Agency of Canada, and local health authorities, would receive only survey responses and the postal code.

Administrative information - Share agreements (ADM2) - Question identifier:ADM2_Q35

These organizations have agreed to keep the data confidential and use it only for statistical purposes.

Do you agree to share the data you provided?

1: Yes
2: No

Administrative information - Share agreements (ADM2) - Question identifier:ADM2_Q37

To reduce the number of questions in this questionnaire, Statistics Canada will use information from your tax forms submitted to the Canada Revenue Agency. With your consent Statistics Canada will share this information from your tax forms with [provincial ministries of health, the Institut de la statistique du Québec, Health Canada and the Public Health Agency of Canada/provincial ministries of health, Health Canada and the Public Health Agency of Canada]. These organizations have agreed to keep the information confidential and to use it only for statistical and research purposes.

Do you give Statistics Canada permission to share your tax information with [provincial ministries of health, the Institut de la statistique du Québec, Health Canada and the Public Health Agency of Canada/provincial ministries of health, Health Canada and the Public Health Agency of Canada]?

1: Yes
2: No

Date modified:: 2023-12-21

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