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. 2025 Aug;20(4):48–56. doi: 10.12927/hcpol.2025.27664

Healthcare Access Gaps Persist for French-Preferring Citizens in Canada's Only Officially Bilingual Province: Analysis of New Brunswick Patient Care Experience Survey Data

Les lacunes en matière d'accès aux soins persistent pour les citoyens qui préfèrent recevoir des services en français dans la seule province officiellement bilingue du Canada: analyse des données du Sondage sur l'expérience vécue par le patient au Nouveau-Brunswick

François Gallant 1,✉, Lise Babin 2, James ted Mcdonald 3
PMCID: PMC12460898  PMID: 40968450

Abstract

Language differences between patients and care providers are a major barrier to delivering quality healthcare. We describe citizen-reported access to healthcare in their preferred official language in New Brunswick by examining survey data from the New Brunswick Health Council (2021 and 2023). Nearly all New Brunswickers report access to a primary care provider in their preferred official language, but other sectors of primary care (e.g., pharmacy, specialists, telehealth) represent significant challenges for French-preferring citizens. Given New Brunswick's unique context as Canada's only officially bilingual province, we highlight research opportunities that could inform strategies to improve language-concordant healthcare nationally.

Introduction

New Brunswick (NB) legally recognizes French and English both as official languages, making it Canada's only officially bilingual province (Canadian Charter of Rights and Freedoms 1982). In the 2021 Census, 26.4% of New Brunswickers reported French as their language most often spoken at home (Statistique Canada 2023b) and 29.5% reported French as their mother tongue (Statistique Canada 2023a), and 34.0% of New Brunswickers are considered bilingual (Statistics Canada 2022). Census data from 2016 indicate that 72% of Francophones in NB are bilingual, compared with 15% of Anglophones (Pépin-Filion and Guignard Noël 2018).

In NB, healthcare is delivered under two regional health networks, which operate throughout the province, but facilities are concentrated in regions aligning with local language contexts (Horizon Health Network 2024; Vitalité Health Network 2024). These health networks are responsible for managing and delivering multiple services, including hospital services, community health centre services, addictions and mental health services and most public health services. Services are offered in a variety of settings; at hospitals on both an in-patient and outpatient basis, at home, in schools, in clinics and other community settings (Government of New Brunswick Canada 2024). New Brunswick's Official Languages Act (NB OLA) imposes on provincial government organizations, including hospitals, the obligation to serve citizens in the official language of their choice. By law, citizens in NB have the right to access healthcare in their preferred official language anywhere in the province. This makes NB an interesting case study in how a system can adapt (or not) to language requirements. Understanding the extent to which services are accessible, why and to whom it matters, and policy responses to language requirements will provide useful information for other Canadian jurisdictions.

The objective of this study is to describe citizen-reported access to healthcare in their preferred official language in NB.

Methods

We report survey data collected by the New Brunswick Health Council (NBHC). The NBHC is a provincial Crown corporation that is funded by the NB Department of Health and is mandated to (1) report publicly on the performance of the provincial health system and (2) engage citizens in the improvement of health services quality (NBHC 2024).

Through surveys, NBHC measures, monitors and evaluates population health and health service quality. This analysis reports on: Hospital Acute Care Survey (2023), Primary Care Survey (2023) and Home Care Survey (2021). The Home Care Survey (2021) examined two types of publicly funded homecare services: Extra-mural program (EMP; health services from health professionals) and home support services (housekeeping, meal preparation, etc.). Given our focus on healthcare services, we only report on EMP results. Table 1 summarizes each survey's purpose, population (number, age, inclusion criteria), and data collection methods. More information on each survey is available on the NBHC website (https://nbhc.ca).

Table 1.

Purpose, population and data collection of three health surveys conducted by the NBHC

Hospital Acute Care Survey Home Care Survey (extra-mural program) Primary Care Survey
Purpose Evaluate the quality of hospital care in NB from the perspective of citizens who have received these services Evaluate the quality of publicly funded home care in NB from the perspective of citizens who receive these services Aims to provide a better understanding of citizens’ experiences with primary care services in NB
Sample
Respondents (n) 4,719 5,718 5,010
Age 18+ years 18+ years 18+ years
Inclusion criteria Patients discharged between April and July 2023, who live in a private household, and received medical, surgical or maternity care during an overnight stay in an NB hospital Patients who received homecare services from the extra-mural program in January 2021 and live in a private household Citizens who live in a private household and have an NB telephone number (landline or cellphone).
Data collection Eligible citizens receive a personalized letter and a bilingual questionnaire from the NBHC in the mail. The survey is to be completed at home by paper (and returned using the postage-paid return envelope provided) or online. Participation is voluntary. Eligible citizens receive a personalized letter and a bilingual questionnaire from the NBHC in the mail. The survey is to be completed at home by paper (and returned using the postage-paid return envelope provided) or online. Participation is voluntary. Random sampling of NB citizens that asks about the availability of primary care services, accessibility of the primary care services that are available to them, and their experiences with the primary care services they received.
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NB = New Brunswick; NBHC = New Brunswick Health Council.

We report percentages of NB citizens who report having received services in their preferred official language with accompanying 95% confidence intervals.

Results

Over 90% of NB citizens report being able to have interactions with their primary care provider in their official language of choice. For all other primary care services in the survey, French-preferring citizens report lower percentages of receiving services in French than English-preferring citizens (Figure 1). Specifically, French-preferring citizens reported having interactions with a medical specialist in French 68.2% (63.4–73.0%) of the time, compared with 95.7% (94.3–97.0%) among English-preferring citizens. Similar results were reported for emergency department visits (French: 69.9% [65.7–74.1%] vs. English: 91.0% [89.3–92.7%]) and pharmacists (French: 68.9% [65.1–72.6%] vs. English: 97.3% [96.6–98.1%]). The largest gap was for eVisitNB, a free telehealth service (French: 48.4% [41.4–55.3%] vs. English: 95.8% [94.1–97.5%]).

Figure 1.

Figure 1.

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Primary Care Survey (2023) results representing the percentage of NB residents receiving services in their preferred official language

Note: EN: Preferred language for services is English; FR: Preferred language for services is French; NB: New Brunswick average. eVisitNB represents a publicly funded episodic virtual care platform in New Brunswick; NB Health Link is a program aimed at improving primary care access to NB residents without a primary care provider; Tele-Care 811 is a referral program for community health services.

In acute care and homecare settings (Table 2), roughly 90% of NB citizens reported being able to receive their services in their preferred official language. However, French-preferring citizens reported lower percentages of always receiving their services in French than English-preferring citizens. Differences by geographic region are consistent, except Madawaska and North-West area, a mainly Francophone geographic area, where French-preferring citizens report always receiving their services in French more often than English-preferring citizens.

Table 2.

Percentage (and 95% confidence intervals) of NB citizens who received their services in their official language of choice in acute hospital care and homecare settings by geographic area

Acute Hospital Care (2023) Home Care Survey (extra-mural program; 2021)
Geographic area Always received services in the preferred language Prefer English/received English, always Prefer French/received French, always Always received services in the preferred language Prefer English/received English, always Prefer French/received French, always
New Brunswick 89.6
(88.9–90.2)		 95.2
(94.7–95.7)		 70.5
(68.4–72.6)		 88.0
(87.3–88.8)		 91.5
(90.7–92.2)		 77.3
(75.2–79.5)
Moncton/South-Easta 86.2
(84.8–97.7)		 91.1
(89.8–92.5)		 74.1
(70.5–77.6)		 88.3
(86.7–89.8)		 90.5
(88.8–92.2)		 82.8
(78.6–87.1)
Fundy Shore and Saint Johnb 95.7
(95.0–96.4)		 99.0
(98.7–99.4)		 37.9
(28.8–47.0)		 91.0
(89.6–82.4)		 91.3
(89.9–92.6)		 s
Fredericton and River Valleyb 95.0
(94.1–96.0)		 97.1
(96.4–97.9)		 s 92.9
(91.7–94.1)		 93.7
(92.5–94.9)		 s
Miramichib 82.0
(77.5–86.5)		 96.3
(93.9–98.7)		 s 89.1
(86.0–92.3)		 76.0
(72.2–79.8)		 66.6
(51.7–81.5)
Madawaska and North-Westc 90.7
(88.3–93.0)		 80.2
(72.6–87.7)		 92.9
(90.2–95.5)		 77.3
(73.9–80.8)		 73.5
(62.2–84.8)		 79.3
(75.5–83.1)
Restigouchec 50.3
(43.9–56.6)		 83.4
(75.2–91.5)		 28.0
(19.8–36.2)		 80.5
(76.3–84.6)		 86.0
(81.1–91.0)		 71.4
(63.4–79.5)
Bathurst and Acadian Peninsulac 75.3
(71.2–79.5)		 71.3
(63.3–79.2)		 75.2
(69.6–80.7)		 79.3
(76.3–72.3)		 88.1
(83.2–93.0)		 76.0
(72.2–79.8)
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a

Designates a bilingual geographic area.

b

Designates a mostly Anglophone geographic area.

c

Designates a mostly Francophone geographic area.

s

= Data suppressed due to confidentiality requirements and/or small sample size. Suppression occurs when the number of respondents is low (n < 30) or when ≤5 respondents endorsed a specific response (e.g., received services in French “Always”) even though the sample size exceeds 30 respondents.

Discussion

French-preferring NB citizens report lower access to services in their preferred official language compared with English-preferring citizens. Roughly one-third of French-preferring citizens report not receiving language-concordant care for all primary care services other than with their primary care provider. Language concordance between patients and healthcare providers has been shown to increase accuracy of patient assessments, examinations, diagnoses and prescribed treatments (Wisnivesky et al. 2012), while language discordance increases the risk of hospital readmission, emergency visit use, adverse events and even death (Reaume et al. 2020, 2022; Seale et al. 2022). While the results presented focus on the official languages of NB, it is important to note that language discordance also affects patients who speak other languages. Specifically, while significant minority populations exist in terms of official languages across Canada, newcomers may not have fluency in either language. In addition, indigenous peoples face unique language barriers in accessing healthcare (Webster 2018). Therefore, efforts should be made to maximize language concordance in healthcare settings.

Data Implications

Although pan-Canadian data are sparse, data from Ontario have been extensively published. These analyses highlight that sharing a primary language with a physician in-hospital leads to better care, with fewer adverse events, lower mortality and shorter stays (Reaume et al. 2020, 2022; Seale et al. 2022). Ontario studies have also highlighted disparities in the distribution of French-speaking physicians and pharmacists, suggesting unequal access to language-concordant care in community settings (Carr et al. 2024; Gauthier et al. 2012; Timony et al. 2013, 2022).

In NB, although nearly all citizens report access to their primary care provider in their preferred official language, future studies are needed to describe the geographic distribution of French-speaking providers (Balzer et al. 2023). This could help contextualize the survey results presented here and allow comparisons with other provinces. For example, knowing the ratio and distribution of French-speaking providers to the population could help understand how language shapes access to healthcare (Carr et al. 2024; Gauthier et al. 2012; Timony et al. 2016, 2022).

Moreover, noting differences identified in reported access by health service, future research should investigate how language preference shapes the process of access to healthcare (Bowen 2003; de Moissac and Bowen 2019; Timony et al. 2016), from perceptions and care-seeking behaviour, to experiences of service use (Levesque et al. 2013).

Policy Implication

Despite the NB OLA, gaps persist when French-preferring citizens access care in the majority Anglophone regions of the province. This is particularly alarming for French-preferring citizens accessing acute care in the Fundy Shore and Saint John area, where the only cardiac surgery centre of the province is located. In addition, pharmacies are exempt from the NB OLA, so they are not obligated to conform to language requirements. However, it seems that pharmacies voluntarily comply with the NB OLA since reported access to pharmacy services for French-preferring citizens was similar to other healthcare services. This is likely due to pharmacies in NB being widely accessible, even in smaller communities, and are likely tailored to the needs of the local population; however, future work should aim to describe language concordance in pharmacy settings (Timony et al. 2022).

Less than half of French-preferring citizens report access to telehealth services, such as eVisitNB, in French. This result echoes multiple complaints about accessing this service in French (Alam 2025; MacKinnon 2024) and is currently under investigation by the Office of the Commissioner of Official Languages (2025). As language barriers may decrease service utilization (Timony et al. 2016; Webster 2018), this may compromise telehealth use by French-preferring citizens. Ongoing work may help understand perceptions and experiences of telehealth use among NB citizens (Lavergne et al. 2025).

Results from this analysis are relevant to the general population, healthcare providers and policy makers. We hope that this evidence helps advocate for advancing language-concordant care and that providers are aware and understand the impact of language discordant care on health outcomes. Supporting novel initiatives, such as Active Offer discussion groups within the Anglophone health authority (Forgues and Paulin 2024), or reassessment of existing policies are needed to improve care pathways and health outcomes of linguistic minority groups. For example, one actionable way to support language concordant care is publicly sharing a provider's language fluency, such as in Nova Scotia (https://cpsnsphysiciansearch.azurewebsites.net/) and Manitoba (https://member.cpsm.mb.ca/member/profilesearch). Nevertheless, information presented here could be leveraged to inform policy and practice across other Canadian jurisdictions, although the breadth and depth of linguistic needs vary across jurisdictions.

Limitations

All data are self-reported and are subject to recall errors, and over- or under-reporting. Since surveys asked for the preferred official language of health services, we are unable to distinguish between this and broader language preference or language spoken at home. These variables do not necessarily reflect an individual's linguistic competence or their level of comfort when communicating in a given language. Considering that some NB citizens may opt for an official language of health service that is different than the language they use at home to facilitate their access to services (e.g., Francophone living in a majority Anglophone area); it is possible that gaps presented here are underreported. Surveys reported were not advertised as “language” surveys but were advertised and promoted as surveys surrounding patient care experiences in healthcare. In addition, we are unable to analyze access gaps by respondent demographics or by health network due to unavailable data, or to study other minority linguistic groups due to small sample sizes. This information would have allowed for a more robust analysis and discussion of access to healthcare based on respondent demographics (e.g., age, sex, country of origin, mother tongue, etc.). Nevertheless, surveys were conducted by research firms with expertise and experience with health surveys, and survey weights were applied to ensure that results are as representative as possible for the population of patients who received health services. The Acute Care Survey and Home Care Survey can be considered an attempted census as all eligible patients received an invitation to participate. Recent methodology changes to the surveys barred comparison across past years of data collection for the Primary Care Survey and the Acute Care Survey, preventing the opportunity to identify trends in the availability of services in each official language in the most recent survey. Finally, we are unable to comment on the impact of urbanization (rural residents, mostly Francophone, are moving to cities) on our results. Centralization of specialist services in the cities may have had an impact on the reporting of results.

Acknowledgments

The authors thank Michel Arsenault, Manager of Data and Analytics at the New Brunswick Health Council, for identifying pertinent data sources and for providing information on data collection and on the technical aspects of the methods used for the surveys. The authors also thank M. Ruth Lavergne for insightful comments on an earlier version of this manuscript.

Contributor Information

François Gallant, Postdoctoral Fellow, Department of Family Medicine, Dalhousie University, Halifax, NS; Vitalité Health Network, Moncton, NB.

Lise Babin, Faculté de médecine, Université de Sherbrooke, Sherbrooke, QC; Vitalité Health Network, Moncton, NB.

James ted Mcdonald, Director, New Brunswick Institute for Research, Data, and Training; Professor, Political Science, University of New Brunswick, Fredericton, NB.

Grants

FG is supported by a MITACS Elevate postdoctoral fellowship, funded through Vitalité Health Network and Dalhousie University.

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