Comparing Canada’s health-care system with other countries, Part 1: Availability of Resources

Comparing Canada’s health-care system with other countries, Part I: Availability of Resources

With the latest omicron wave of COVID ending, and provinces beginning to lift major restrictions, life in Canada is starting to return to normal. Unfortunately for Canadians, the pre-pandemic normal means continued scarcity of needed medical resources, long wait times for elective procedures and overcrowded hospitals.

This blog is the first in a series that examines the pre-pandemic performance of Canada’s health-care system in four key areas of resource availability, utilization, timely access and clinical performance.

As a fundamental component of a properly functioning health-care system, the availability of medical resources has important implications. A report released last year by the Fraser Institute found that Canada had significantly fewer human and capital medical resources compared to its international peers.

Health-care capital resources typically refer to hospitals, beds and equipment—which all must be available if a system’s human health resources are to be used effectively. In 2019 (after adjusting for population age), Canada only had 2.0 acute care beds per 1,000 population, ranking 25th out of the 26 countries where data were available. By contrast, Germany has almost three times as many beds (5.5 per thousand) while countries such as Switzerland and France had approximately 3 or more acute care beds per thousand. Unsurprisingly, news stories of overcrowded hospitals due to a shortage of beds were commonly reported in Canada even before the pandemic.

Figure 1. Canadian Rank for Medical Resources

	Physicians (per 1,000)	Nurses (per 1,000)	Acute Care Beds (per 1,000)	CT Scanners (per million)	MRI Machines (per million)
Canada's Rank	26th out of 28	14th out of 28	25th out of 26	22nd out of 26	21st out of 24

This relative scarcity of medical resources also extends to key diagnostic equipment such as MRI machines (which Canada, after adjusting for age, ranked 21st out of 24 countries) and CT scanners (22nd out of 26). Compared to Canada, Germany reported nearly three times as many MRI units (ranking 3rd) while Australia had five times as many CT scanners (ranking 2nd).

Despite their crucial nature, most capital health-care resources including hospitals, beds and equipment almost always have to be put to use in combination with human health resources (i.e. physicians and nurses). Unfortunately, in 2019 Canada reported fewer physicians (after adjusting for age) than most other universal health-care systems ranking 26th out of 28 with only 2.8 per 1,000 population, far below the average for universal health-care countries (3.8). Results improved moderately, however, with nurse availability per 1,000 population (ranking 14th out of 28 ). Again, compared to Canada, Switzerland had 1.6 times as many physicians per 1,000 population (ranking 7th for physician availability) and 1.75 times as many nurses (ranking 2nd).

Given these figures, it may be tempting to suggest the answer is to increase supply by pumping more money into the system, building hospitals, purchasing equipment, training physicians and hiring nurses.

But in reality, money isn’t the problem. After adjusting for age, Canada ranks as the second-highest health-care spender (out of 28 countries) as a percentage of GDP and the 8th highest per person.

Figure 2. Spending as a % of GDP and Rank 2019

	Australia (% and Rank)		Germany (% and Rank)		Netherlands (% and Rank)		Canada (% and Rank)		Switzerland (% and Rank)
2019	10.30%	9 of 28	10.80%	4 of 28	10.10%	12 of 28	11.30%	2 of 28	11.40%	1 of 28

Given these results, two things are clear. First, there’s a scarcity of key medical resources in Canada compared to peer countries with universal health care. Second, there’s an imbalance between how much we spend on health care and the value we receive in return.

Evaluating health-care performance is complex; no single measure or indicator tells the whole story in isolation. This rule also extends beyond just looking at resource availability compared to spending and into other measurable areas as well. This blog series will examine these other important areas of health-care system performance including the utilization of resources, the access citizens have to those resources, and indicators of clinical performance and quality.