Canada ranked last in access to primary health care in a survey of 10 high-income countries released by the Canadian Institute for Health Information on Thursday.

Eighty-six per cent of Canadians aged 18 and older said they had a doctor or a place they usually go for medical care in the 2023 survey by the Commonwealth Fund.

That's down from 93 per cent of those surveyed in 2016 - and means that an estimated four million Canadian adults did not have access to primary care last year, the study said.

The percentage of people who had access to primary care was lower than in any of the other countries surveyed, which included Australia, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom and the United States.

The average among all 10 countries was 93 per cent.

The Netherlands had the best ranking, with 99 per cent of adults living there reporting they had access to primary care in 2023.

The United States performed only slightly better than Canada, with 87 per cent of American adults saying they had primary care access.

Canada also ranked last in ability to get a same or next-day appointment to see a doctor or nurse.

Only 26 per cent of Canadian adults were able to get medical attention that quickly, down from 46 per cent in 2016.

The survey also revealed that Canadians with lower household incomes were less likely to have a primary care provider than those with higher incomes.

It also found that 39 per cent of Canadians without primary care had at least one chronic health condition and 29 per cent were taking one or more prescription medications.

The 2023 Commonwealth Fund also surveyed participants about their mental health.

It found the COVID-19 pandemic, together with economic stressors, was taking a toll on Canadians, with 29 per cent of adults reporting depression, anxiety or another mental health condition in 2023.

The Commonwealth Fund is a U.S.-based non-profit foundation that funds surveys of patients and health-care providers in multiple countries. CIHI is the Canadian partner.

Researchers conducted interviews between March and August 2023. In Canada, 4,820 people were interviewed.

This report by The Canadian Press was first published March 21, 2024.