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The
Economic Freedom
Network

  
Public Policy Sources

Public Policy Sources #28:
Canada Compared with the OECD

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In terms of technology per capita, Canada is clearly not a world leader (see table 1), despite the fact that it is the fifth highest among OECD countries in terms of its spending on health (as a percentage of GDP). The data show that most OECD nations provide greater accessibility than Canada to a number of important technologies: computed tomography (CT) scanners, radiation equipment, lithotriptors, and magnetic resonance imagers (MRIs). At the same time, most countries also spend a smaller proportion of their national income on health care (see table 2).

Specific technologies: CT, radiation, lithotriptors, MRIs

The CT scanner is one of the best known and most useful diagnostic tools available to physicians. By combining the use of a computer and X-rays, cross-sectional images of the body are taken. This technology has been very useful in the diagnosis and treatment of cancer, head injuries, and strokes. The diffusion of CT scanners has been widespread, reaching all OECD nations. The diffusion has, however, been far from even (see table 3). The average accessibility in the OECD is 12.9 CT scanners per million persons, well above the comparable figure for Canada, 8.1 scanners per million persons. Indeed, 20 of the 28 OECD nations provide easier access than Canada does. 8

A second technology that the OECD measures is the number of radiation machines dedicated to the treatment of cancer (see table 4). This category includes resources such as cobalt-60 centres and linear accelerators. It is the only category where Canada's accessibility rate is above the OECD average of 4.8 per million persons. With 5.3 units of radiation equipment per million persons, Canada finishes sixth among the 16 nations that record such data.

Lithotriptors provide physicians with a non-invasive method for removing stones lodged in the kidney or ureter. A lithotriptor bombards a stone with shock waves and breaks the stone down into finer particles, which the body then can excrete naturally. The procedure dramatically decreases pain and suffering compared to surgery or waiting for the patient to excrete the smaller stones spontaneously. Unfortunately, Canada has only 0.4 lithotriptors per million persons (see table 5). The OECD average is 1.4 per million, more than three times the Canadian level. Italy, for example, now has more than ten times the number of lithotriptors per capita as Canada although it spends a smaller share of its GDP on health care than Canada does.

A magnetic resonance imager (MRI) is an imaging device that provides cross-sectional and three-dimensional views of tissues that have high fat or water content. This technology was developed to image the brain and spinal cord, but has also subsequently been useful in diagnosing orthopedic conditions. In the early 1980s, Canada had a high stock of MRIs relative to other developed nations. However, since that time Canada's position has slipped: 18 countries now have more MRIs per capita than Canada (see table 6). At 1.7 MRIs per million persons, Canada is well below the OECD average of 3.9 per million. The lack of MRIs in Canada is delaying the diagnosis of many conditions and causing some patients to undergo surgery without a properly defined diagnosis.

Diffusion of MRIs over time

Data from previous years on the availability of MRIs was also analyzed to provide a time-series depicting the rate of diffusion of MRIs. Technological diffusion over time is an indicator of the restrictions regulatory bodies and funding agencies place on a technology. Data from the OECD compares the availability of MRI scanners in the first five years of their general availability with their spread over the next five years (see figure 2 and figure 3). Diffusion of MRIs in other countries has been much more rapid than in Canada. In France, the increase of MRI equipment per capita occurred more rapidly in private hospitals than public hospitals. 9 In the United States, rapid diffusion of MRIs occurred in clinics not connected to hospitals. Some countries with faster diffusion also have improved the design, developing, for example, "open" MRI scanners that do not require complete enclosure of the patient. This reduces the occurrence of claustrophobia, which causes up to 10 percent of examinations to be aborted due to a panic reaction by the patient. 10

Table 1: Canadian Medical Technology and Health Spending Relative to the OECD, 1997a

Technology

Canadian
Valueb

OECD
Average

Canadian
Rank

Sample
Size

CT Scanners

 8.1 12.9

21

28

Radiation Equipment

 5.3 4.2

6

17

Lithotriptors

 0.4 1.4

19

22

MRIs

 1.7 3.9

19

27

National Health Expenditure 1997

9.3% of GDP

7.7% of GDP

5

29

a Not all countries reported 1997 figures for all categories. Country-specific dates are included in Tables 2-6.

b Number per million population, except where noted (last row of table).

Source: OECD Health Data 98. Paris: OECD, 1998.

Table 2: Total Health Care Expenditure as Percent of GDP, 1997

Rank

Country

% of GDP

Rank

Country

% of GDP

1

United States

 13.6

16

Denmark

 7.4

2

Germany

 0.4

17

Spain

 7.4

3

Switzerland

 10.1

18

Japan

 7.3

4

France

 9.6

19

Finland

 7.2

5

Canada

9.0

20

Greece

 7.1

6

Sweden

 8.6

21

Luxembourg

 7.1

7

Netherlands

 8.5

22

Czech Republic

 7.0

8

Australia

 8.4

23

Ireland

 7.0

9

Portugal

 8.2

24

United Kingdom

 6.7

10

Iceland

 8.0

25

Hungary

 6.5

11

Austria

 7.9

26

Poland

 5.2

12

New Zealand

 7.7

27

Mexico

 4.7

13

Belgium

 7.6

28

Korea

 4.0

14

Italy

 7.6

29

Turkey (1996)

 3.8

15

Norway

 7.5

Average for OECD

7.7

Source: OECD Health Data 98. Paris: OECD, 1998.

Rank

Country

Scanners

Health Spending
(% of GDP)

1

Japan (1996)

 69.7 7.2

2

United States (1993)

 26.9 14.1

3

Austria (1997)

 24.8 7.9

4

Australia (1994)

 18.4 8.5

5

Switzerland (1993)

 17.7 9.4

6

Italy (1995)

 17.5 7.7

7

Korea (1997)

 17.4 4.0

8

Belgium (1994)

 16.7 8.0

9

Germany (1996)

 16.4 10.5

10

Luxembourg (1990)

 15.7 6.6

11

Iceland (1997)

 14.8 8.0

12

Sweden (1993)

 13.7 8.9

13

Portugal (1990)

 12.0 6.5

14

Norway (1990)

 11.6 7.8

15

France (1996)

 9.4 9.7

16

New Zealand (1997)

 9.2 7.6

17

Finland (1990)

 9.0 8.0

18

Netherlands (1993)

 9.0 9.0

19

Spain (1996)

 9.0 7.4

20

Czech Republic (1997)

 8.3 7.0

21

Canada (1997)

8.1 9.3

22

United Kingdom (1993)

 6.3 6.9

23

Greece (1990)

 6.1 4.2

24

Denmark (1990)

 5.8 8.2

25

Hungary (1996)

 5.1 6.7

26

Ireland (1990)

 4.3 6.7

27

Mexico (1990)

 2.1 3.6

28

Turkey (1990)

 1.6 3.6

OECD average

13.1 7.5

Source: OECD Health Data 98. Paris: OECD, 1998.

Table 4: Radiation Treatment Equipment per Million Population

Rank

Country

Radiation Treatment Equipment

Health Spending
(% of GDP)

1

Iceland (1997)

 14.8 8.0

2

New Zealand (1997)

 8.2 7.6

3

France (1996)

 7.6 9.7

4

Greece (1994)

 6.5 5.4

5

Czech Republic (1997)

 6.4 7.0

6

Canada (1997)

5.3 9.3

7

Finland (1988)

 4.9 7.3

8

Germany (1996)

 4.7 10.5

9

Australia (1992)

 3.8 8.6

10

Korea (1997)

 3.8 4.0

11

United States (1992)

 3.8 13.9

12

Austria (1997)

 3.7 7.9

13

Hungary (1996)

 3.3 6.7

14

Spain (1996)

 3.3 7.4

15

Sweden (1993)

 0.8 8.9

16

Portugal (1996)

 0.5 8.3

17

Poland (1993)

 0.1 4.9

OECD average

4.8 8.0

Source: OECD Health Data 98. Paris: OECD, 1998.

Table 5: Lithotriptors per Million Population

Rank

Country

Lithotriptors

Health spending
(% of GDP)

1

Italy (1995)

 4.6 7.7

2

Iceland (1997)

 3.7 8.0

3

Korea (1997)

 3.4 4.0

4

Greece (1994)

 3.3 5.4

5

Czech Republic (1997)

 3.0 7.0

6

Japan (1990)

 2.5 6.0

7

Spain (1996)

 1.8 7.4

8

Germany (1996)

 1.7 10.5

9

Austria (1997)

 1.6 7.9

10

Belgium (1992)

 1.6 8.0

11

United States (1990)

 1.5 12.6

12

Portugal (1996)

 1.2 8.3

13

Australia (1994)

 1.0 8.5

14

France (1996)

 0.8 9.7

15

Ireland (1988)

 0.8 7.0

16

Netherlands (1990)

 0.8 8.3

17

Hungary (1996)

 0.7 6.7

18

New Zealand (1996)

 0.5 7.3

19

Canada (1995)

0.4 9.3

20

Sweden (1993)

 0.3 8.9

21

Finland (1988)

 0.2 7.3

22

Mexico (1990)

 0.2 3.6

OECD average

1.7 7.9

Source: OECD Health Data 98. Paris: OECD, 1998.

Table 6: MRIs per million Population

Rank

Country

MRI

Health Spending
(% of GDP)

1

Japan (1996)

 18.8 7.2

2

United States (1995)

 16.0 14.1

3

Austria (1997)

 8.4 7.9

4

Switzerland (1993)

 7.4 9.4

5

Sweden (1995)

 6.8 8.5

6

Germany (1996)

 5.7 10.5

7

Korea (1997)

 5.1 4.0

8

Netherlands (1995)

 3.9 8.8

9

Italy (1995)

 3.5 7.7

10

United Kingdom (1995)

 3.4 6.9

11

Belgium (1995)

 3.3 7.9

12

Spain (1996)

 3.2 7.4

13

Australia (1995)

 2.9 8.4

14

Portugal (1996)

 2.8 8.3

15

New Zealand (1997)

 2.7 7.6

16

Denmark (1990)

 2.5 8.2

17

Finland (1990)

 2.4 8.0

18

France (1997)

 2.4 9.9

19

Canada (1997)

1.7 9.3

20

Hungary (1996)

 1.4 6.7

21

Czech Republic (1997)

 1.3 7.0

22

Greece (1994)

 1.2 5.4

23

Norway (1990)

 0.7 7.8

24

Ireland (1990)

 0.3 6.7

25

Turkey (1990)

 0.3 3.6

26

Mexico (1990)

 0.2 3.6

27

Poland (1993)

 0.1 4.9

OECD average

4.2 7.9

Source: OECD Health Data 98. Paris: OECD, 1998.

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