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Research Public Perceptions of the Cost of Paramedic Services in Saskatchewan, Canada

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Research Public Perceptions of the Cost of Paramedic Services in Saskatchewan, Canada Research Public perceptions of the cost of paramedic services in Saskatchewan, Canada Adeyemi Ogunade MS, PhD, is a Post-doctoral Research Fellow1; Florence Luhanga RN, MEd, PhD, is Associate Professor1; Jacquie Messer-Lepage BMLT(Microbiology), MBA, is Executive Director/Registrar2; Khan MD Rashed Al-Mamun MS, MPA, is Senior Policy and Research Analyst2 Affiliation: 1Faculty of Nursing, University of Regina, Saskatchewan, Canada 2Saskatchewan College of Paramedics, Canada https://doi.org/10.33151/ajp.18.889 Abstract Introduction Despite the increasingly important role of paramedics in Canada’s healthcare system, the Canadian Health Act does not cover paramedic services. Anecdotal evidence indicates that the cost of paramedic services prevents many people in need from accessing this care. This article explores public perceptions of the cost of paramedic services in Saskatchewan, Canada. Methods Using a qualitative research design, we collected data from 56 participants in focus group sessions and semi-structured interviews designed to explore perceptions of paramedic services in Saskatchewan. Results The data indicated that participants perceived the cost of paramedic services to be too high, and that this perception may limit the use of paramedic services during medical emergencies. The data also suggested a lack of understanding of how paramedic service costs are calculated. Overall, participants expected the government to do more to subsidise these costs. Conclusion The results revealed a disconnect between public perceptions about the cost of paramedic services and the initiatives designed by the provincial government to alleviate these costs. They also highlight the need for better public education about and access to government programs designed to alleviate the cost of paramedic services. Keywords: cost of paramedic services; framework approach; paramedic; public health policy; Canada; Saskatchewan Corresponding Author: Adeyemi Ogunade, [email protected] 01 Ogunade: Public perceptions of the cost of paramedic services Australasian Journal of Paramedicine: 2021;18 Introduction Methods Paramedic services dispense pre-hospital treatment and Study design transport for potentially life-threatening injuries or illness. These This study employed a qualitative descriptive research design public services are critical to emergency health care delivery (13,14) to explore public perceptions and experiences related in countries around the world. In Canada, paramedics provide to paramedic care in Saskatchewan. This approach allows several community services, including emergency interventions for complexity and nuance in data collection, analysis and to mitigate morbidity associated with injury or illness; non-urgent, interpretation and thus facilitates in-depth understanding of primary, and preventative care; and health education (1,2). patient experiences (15). We conducted data collection and Unlike the Franco-German paramedic model in which physicians analysis concurrently using the framework approach, an applied staff ambulances for direct admission to hospital wards (3,4), qualitative research method developed in the 1980s by Ritchie Canada follows the Anglo-American model in which professional and Spencer (16). This systematic and transparent method of paramedics staff ambulances and administer treatment while evaluating qualitative data in applied policy research comprises ensuring safe transport to an emergency department. In Canada, five distinct but connected stages: familiarisation, identification this model has evolved to include primary, preventive and of a thematic framework, indexing, charting, and mapping and chronic health care delivery (5-7). interpretation. The stages are non-linear and iterative, each one informing the next and looping back to the previous to establish The Canada Health Act is the flagship federal legislation that a series of interconnected qualitative data management establishes a framework for provinces and territories to obtain procedures, which can be used to create an audit trail (16). federal cash contributions for insured health services, which in Interviews and focus groups were used to collect data. The turn minimises residents’ financial barriers to health services (8). semi-structured interview approach allowed for deep exploration Despite the critical role paramedics play in health care delivery and elaboration of answers (17,18). To aid in conducting these sessions, the research team consulted the literature to develop in Canada, the Canada Health Act does not include paramedic a focus group and interview guide. Before each interview and services in its list of insured health services. Instead, insurance focus group session, demographic data (gender, age, race, coverage of paramedic services relies on a patchwork of location) were collected from each participant. legislation at the provincial level of government. Consequently, unlike most health services, users cover the costs of paramedic Participants services in most provinces. The growing importance of A combination of non-probability purposive sampling and paramedic services to health care delivery in Canada and the snowball sampling was used to recruit key informants from lack of coverage for such care has raised concerns that those in different population groups (eg. seniors, inner-city residents, need may not be able to access this service (9,10). rural residents, new immigrants). To implement purposive sampling, the research team sent copies of the recruitment flier Some studies have examined public perceptions of the to community associations in Regina, Saskatoon and Prince cost of paramedic services. Crowe et al (11) assessed the Albert. This approach ensured that participants recruited for the experience and perception of paramedics in the United States study were Saskatchewan residents. Participants who received and found that most participants (85.3%) who were billed for the flier and decided to participate contacted the researchers by paramedic services believed that the service was worth the telephone, who then informed them of the purpose of the study cost. They did not explore whether participants were aware and their rights as participants. of the costs of paramedic services before calling, the impact of this knowledge on the decision to call the paramedics, or During the telephone interviews, some participants indicated whether the demographic profile of participants influenced they had acquaintances who lived in Saskatchewan, had perceptions of cost. Moreover, the study design used landline experience with paramedic services and were interested in telephone numbers, which researchers noted could have interviewing for the study. The research team asked those skewed the sample towards white, older, educated and participants to pass along the researchers’ contact information, conservative respondents (11). These participants likely and telephone interviews were subsequently scheduled with could afford insurance coverage for paramedic services, thus these acquaintances using this snowball sampling technique. influencing their perceptions of the costs. Blomstedt, Nilsson The study comprised 56 participants in focus groups and and Johansson (12) investigated public use, knowledge and semi-structured individual interviews. Participant demographic expectations of paramedic services in Skane, Sweden, although information is shown in Table 1. they did not address public perceptions of cost. As part of a larger study examining public perceptions of paramedic care in Procedures Saskatchewan, this study aimed to assess public perceptions of Data collection occurred from November 2019 to September the costs of these services and how those perceptions affect the 2020. The project launched on 28 November 2019 with a focus use of emergency services among various groups. group session in Regina comprising 13 participants, followed 02 Ogunade: Public perceptions of the cost of paramedic services Australasian Journal of Paramedicine: 2021;18 Table 1. Participant demographic information Participant # Gender Age (years) Ethnicity Location 1 Female 45-64 Caucasian Regina 2 Male 18-24 Black/African Regina 3 Female 25-34 Black/African Regina 4 Female 35-44 East Asian Regina 5 Male 18-24 Black/African Regina 6 Female 25-34 South Asian Regina 7 Male 45-64 South Asian Regina 8 Male 45-64 South Asian Regina 9 Female 45-64 Caucasian Regina 10 Male 25-34 Black/African Regina 11 Male 25-34 East Asian Regina 12 Female 25-34 Black/African Regina 13 Male 18-24 Black/African Regina 14 Male 18-24 Black/African Regina 15 Male 45-64 Indigenous Regina 16 Female 45-64 Indigenous Regina 17 Male 45-64 Indigenous Regina 18 Male 25-34 Indigenous Regina 19 Male 35-44 Indigenous Regina 20 Male 35-44 Indigenous Regina 21 Female 45-65 Indigenous Regina 22 Female 45-65 Indigenous Regina 23 Female 45-65 Indigenous Regina 24 Male 35-44 Indigenous Regina 25 Male 45-65 Indigenous Prince Albert 26 Male 45-65 Indigenous Prince Albert 27 Female 45-65 Caucasian Prince Albert 28 Female 65+ Caucasian Prince Albert 29 Male 45-65 Indigenous Saskatoon 30 Female 35-45 Black/African Regina 31 Male 35-45 Caucasian Regina 32 Female 35-45 Caucasian Regina 33 Female 35-45 Caucasian Regina 34 Female 65+ Caucasian Saskatoon 35 Female 65+ Caucasian Saskatoon 36 Female 65+ Caucasian Saskatoon 37 Male 35-45 Black/African Regina 38 Female 65+ Caucasian Saskatoon 39 Female 65+ Caucasian Saskatoon 40 Female 65+ Caucasian Saskatoon 41 Male 65+ Caucasian Saskatoon 42 Female 45-64 Black/African
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