Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
Table 4.2
Operating indicators for hospital-based acute care in Canada and selected countries,
2008
Average length of stay
(in days)
Number of bed days
(per capita)
Occupancy rate
(% of available beds)
Turnover rate
(cases per
available bed)
Australia 5.9 1.0 73.2 45.6
Canada 7.7 0.8 93.0 36.6
France 5.2 1.0 74.2 51.8
Sweden 4.5 – – –
United Kingdom 6.9 0.8 84.8 48.9
United States 5.5 0.6 66.4 44.2
Source: OECD (2011a).
Note: OECD data for bed days, occupancy rate and turnover rate for Sweden not available.
Since almost all hospital care is considered a fully insured service under the
Canada Health Act, public funding is critical to decisions concerning capital
expansion and improvement. Public budgeting rules require that governments
and their delegates (including RHAs) carry capital expenditures as current
liabilities. As a consequence, there has been an incentive to reduce capital
expenditures more than operating expenditures during periods of budgetary
restraint. In addition, governments sometimes prefer not to carry the burden of
financing infrastructure “up front”.
While some governments and RHAs have explored private finance
initiatives (PFI) – known as public–private-partnerships or “P3s” in Canada – it
has been more common to contract out care to private companies or professional
corporations. Almost all medical laboratories and diagnostic clinics are owned
by private corporations (Sutherland, 2011b).
4.1.3 Medical equipment
Canada has a decentralized process of purchasing most medical aids and devices,
consistent with a decentralized delivery system. Although provincial ministries
of health are ultimately responsible for ensuring the availability and quality of
medical equipment, devices and aids as part of first-dollar coverage for hospital
and medical services, arm’s length health organizations and providers actually
purchase most medical aids and devices. In addition, most physicians maintain
private offices and make independent decisions concerning the purchase of a
broad range of medical equipment, devices and aids to support their respective
general (family) and specialist practices.