Canada - World Health Organization Regional Office for Europe

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84 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.
Health systems in transition Canada 85 In both regionalized and non-regionalized provinces, individual clinicians, particularly specialist physicians, play a major role in the decisions of RHAs and hospitals to purchase medical equipment, including the selection of a particular vendor. At the same time, provincial health ministries can play a key role in determining the timing and procurement of extremely expensive medical equipment, especially magnetic resonance imaging (MRI) units and computed tomography (CT) scanners. From the early to mid-1990s, provincial governments severely constrained their spending on advanced diagnostics. These actions created a bottleneck, lengthening waiting times for certain conditions and treatments (Romanow, 2002). Since that time, there has been a substantial investment in advanced diagnostics by provincial health ministries and delegated RHAs. As can be seen in Table 4.3, Canada now has a supply of CT, MRI and positron emission tomography (CIHI, 2012a) scanners roughly comparable to the supply in Australia (except for CT scanners), France and the United Kingdom. Table 4.3 Number of selected diagnostic imaging technologies, per million population, in Canada and selected countries, 2010 CT MRI PET Australia 42.5 5.8 1.4 Canada 14.4 8.4 1.2 France 11.8 7.0 0.9 United Kingdom 8.3 6.0 0.5 United States 34.3 25.9 3.1 Source: OECD (2011a). Notes: Data for Sweden were not available; CT: Computed tomography; MRI: Magnetic resonance imaging; PET: Positron emission tomography. Although Canada is still well below the supply of similar technologies in the United States, the simple counts of advanced technologies do not take into consideration the intensity of use, and there is evidence that advanced diagnostic technologies in Canada, particularly those that are hospital based, are more intensely used than the same imaging technologies in the United States. In fact, based on 2007 data, Canada ranked among the European countries with the highest utilization efficiency of MRI scanners, with the number of examinations per MRI in unit second only to Belgium, and higher than France, Sweden and the United Kingdom (CIHI, 2008b).
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Contents Preface . . . . . . . . .
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Preface The Health Systems in Trans
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Acknowledgements The HiT on Canada
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List of abbreviations Abbreviations
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Abstract Canada is a high-income co
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The European Observatory on Health
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Canada - World Health Organization Regional Office for Europe

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