One in four Canadians earning less than $30,000 annually have delayed or stopped taking prescription drugs because they did not have money to pay for the treatment, a new poll shows.

By contrast, fewer than one in 30 citizens earning more than $60,000 a year has had trouble paying for necessary medication, according to the survey commissioned by the Canadian Medical Association.

That is just one striking example of the growing inequality in access to health care, John Haggie, president of the CMA, said in an interview.

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"This is a significant problem that needs to be addressed," he said.

The polling suggests that the health status of low-income Canadians is also deteriorating, Dr. Haggie said.

Thirty-nine per cent of those earning less than $30,000 a year said their health was excellent or good, compared to 68 per cent of those who earned $60,000 or more.

That gap – 29 percentage points – is significantly higher than in a poll done in 2009, when the gap was 17 per cent.

"What is particularly worrisome for Canada's doctors is that in a nation as prosperous as Canada, the gap between the haves and have-nots appears to be widening," Dr. Haggie said.

The problem, he said, is that the public insurance system has not kept pace with the needs of patients. Medicare currently covers all physician and hospital services, so it meets the needs of patients with acute health problems. But medicare does not necessarily cover prescription drugs, home care and long-term care, which are necessities for most people with chronic illnesses, Dr. Haggie said.

"Medicare 1.0 was very good for short-term episodic care," he said. "But we need medicare 2.0 now because 80 per cent of health-care needs now come from patients with chronic illnesses."

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Canadians currently depend on supplementary insurance to pay for services not provided under medicare. But about six million citizens lack private insurance for things like prescription drugs, vision care and physiotherapy, said Maureen O'Neil, chief executive of the Canadian Health Services Research Foundation.

That is costly, not only to their health, but to society more generally, she said. "When people can't afford the health care they need, there are economic costs both through reduced productivity and great health-care expenditures down the road," Ms. O'Neill said.

The survey also shows that those with low incomes tend to be less healthy and use more health services: 59 per cent of low-income Canadians used health services in the past month, compared to 43 per cent of those with higher incomes.

The polling was conducted by Ipsos Reid. It included 1,004 online respondents and 1,200 more surveyed by telephone, all in late July. The findings are considered accurate within 2.8 percentage points, 19 times out of 20. This is the 12th year that the CMA, which represents 76,000 physicians, interns, residents and medical students, has produced a report card. Among other things, it asks Canadians to assign a letter grade to the performance of various players in the health system.

In the main, Canadians show high levels of satisfaction with their care. For example:

– 74 per cent grade the overall quality of care in the A-B range, and 5 per cent give it a F;

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– 72 per cent graded their most recent experience in the health system with an A or B, and 7 per cent a failing grade;

– 69 per cent gave an A or B to the choice of health services in their community.

Those with a regular family physician were the most likely to give high marks. Similarly, those over the age of 55 were the happiest with the system's performance.

At the same time, however, those polled showed much frustration with political oversight of the health system, as reflected by these numbers:

– 36 per cent gave the federal government an A or B, while 22 per cent assigned it a failing grade. Residents of Ontario were, by far, the most pleased with Ottawa's performance;

– 37 per cent gave their provincial government an A or B, and 22 per cent an F. Provinces got better scores than Ottawa in every part of the country except Ontario.

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The poll shows that, when it comes to the future prospects of the health system, Canadians are pretty well divided between optimism and pessimism, with 48 per cent predicting health services will get worse and 36 per cent saying they will get better.

The most optimistic respondents were in Alberta and Saskatchewan, while the most pessimistic were in B.C. and Quebec.