CIHI report shows access to primary care going from best to worst in Atlantic Canada

With access to primary health care being a central issue in Nova Scotia’s election campaign it’s a bit surprising that last week’s report on the subject from the Canadian institute for Health information (CIHI) has so far received little attention. Entitled “Taking the pulse”, the report measured for each Province and Territory progress in responding to a set of health care priorities that were agreed to as part of the February 2023 federal-provincial-territorial health deal.

There are five priority areas – including wait times for joint replacements and community mental health counselling – but in the current Nova Scotia context, the hot button political measurement is access to primary care. On that score, CIHI reports that only 79.2 percent of Nova Scotians 18 and over had access to a doctor or nurse practitioner in 2023, leaving 20.8 percent – about 180,000 individuals 18 and over – without a regular health care provider.   

That number casts a bit of a shadow over the Oct. 17 good news announcement from the Houston government that the number of Nova Scotians on the Need a Family Practice Registry had dropped to 145,114, about 7,000 below the total 15 months earlier. The opposition were quick to point out that even with a recent reduction, the numbers have doubled since the PCs took office. Last week’s report from CIHI will give the opposition parties even more grounds for criticism, but from a different perspective. 

Using the registry as a club to bludgeon the government’s record on access to care has never been entirely accurate or fair. The registry started from scratch, so naturally it grew as more and more people took advantage of the service being provided. It was never a true reflection of how many Nova Scotians were without a primary health care provider. It just shows how many have registered asking for help finding a physician or nurse practitioner. Moreover, the registry doesn’t enable comparison with other provinces.

For estimates of how many Canadians and Nova Scotians have access to a regular health care provider we need to rely on Statistics Canada’s biennial Community Health Survey, which was the basis of CIHI’s “Taking the pulse” report. Those surveys show an alarming increase in recent years in the percentage of those without access to primary care, not only in Nova Scotia, but throughout Atlantic Canada. The table below shows that increase between 2015 and 2023.

Percentage without primary care access by year

	2015	2019	2021	2023
Canada average	16.8%	14.4%	14.4%	17.2%
Nova Scotia	11.3%	14.4%	13.7%	20.8%
Newfoundland	11.9%	12.5%	12.5%	21.9%
Prince Edward I.	11.3%	14.9%	19.5%	26.9%
New Brunswick	9.2%	10.2%	10.2%	18.0%

 Source: Statistics Canada, CIHI

There is one important caveat to be noted. The percentages from 2015, 2019 and  2021 are calculated based on population 12 years and older. The 2023 numbers are based on population 18 and over. Part of the increase may be because the 13-17 age group, likely to have access through their parents, are removed from the sample. But whatever the explanation, there is an element of apples with oranges when comparing 2023 with earlier years. However, if you compare where Nova Scotia and the other Atlantic Provinces stood in 2015 and 2023 relative to the national picture the deteriorating situation in Atlantic Canada becomes apparent.   

Percentage and rank without primary care

	2015	2015 rank of 9	2023	2023 rank of 9
Nova Scotia	11.3%	3rd best (Tie)	20.8%	3rd worst
Newfoundland	11.9%	4th best	21.9%	2nd worst
Prince Edward I.	11.3%	3rd best (Tie)	26.9%	Worst
New Brunswick	9.2%	Best	18.0%	4th worst (Tie)

Source: Statistics Canada, CIHI

As the Table shows, the Atlantic Provinces went from having among the lowest percentage of persons without access to primary care in 2015 to the among the highest in 2023 (New Brunswick tied with British Columbia for fourth highest. Data for Quebec were not available).

What these numbers tell us – and keeping in mind the caution about comparing 2023 with earlier estimates – is that Nova Scotia and the rest of Atlantic Canada are falling behind other provinces in providing access to primary care. In 2015 the Atlantic Provinces had among the lowest numbers without access to primary care; in 2023 they had among the highest. That is a sharp reversal over the eight-year period from 2015 to 2023.  

When the subject of access to primary care comes up, the Nova Scotia government often deflects criticism by saying it’s a national problem. But the report from CIHI suggests a different tale – the access problem has quickly become worse in Atlantic Canada, a recent development that needs explanation.

It could be a matter of poor performance by provincial governments, but the fact that all four have fallen on hard times leads to the possibility that the problem may be systemic, the result of insufficient resources meeting the challenges posed by the age and health status of our populations. 

There used to be a lot of talk about a “demographic top-up”component in federal health transfers (discussed here) to reflect greater health care needs in provinces with older populations. Atlantic Premiers and Health ministers, despite the support of heavyweights like the Canadian Medical Association and the Conference Board, failed to make that case with the Trudeau Liberals. The provinces eventually stopped talking about it and settled for the February 2023 health deal which makes only a small concession to that principle.    

A Nova Scotia government that thrives on conflict with the federal government could perhaps have added health funding to its list of complaints. But then that government would first have to admit it has a serious problem – an acknowledgement inconsistent with its “fix health care” claims.

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