By NextBestFitSeparate public capital budget, planned regionally
New buildings and major equipment are funded by a separate capital budget allocated by regional need, not from operating revenue.
Regional capital planning.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Create a separate capital budget allocated by regional need
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Under-investment in equipment and facilities
A separate capital budget allocates buildings and major equipment by regional need rather than operating revenue, allowing investment in underserved areas. Capital funding remains easy to cut when budgets are tight.
- Low-value care and overtreatment
Allocating major equipment through a separate regional capital budget prevents duplicate equipment arms races.
- Racial, income, and geographic disparities
Allocating capital by regional need allows investment to be directed to underserved areas.
- Takes years, or money up front, before it pays off
Regional allocation through a separate capital budget can involve slow approvals.
- Fixed budgets can ration care
A separate capital budget is vulnerable to cuts when budgets are tight.
Who's affected
- People with ongoing or specialist care needs
- Under-investment in equipment and facilities: Underinvestment in diagnostic equipment leaves them waiting for tests.
- Low-value care and overtreatment: Low-benefit tests and treatments expose them to harm.
- Residents of areas with too few health professionals
- Under-investment in equipment and facilities: A separate capital budget allocates buildings and major equipment by regional need rather than operating revenue, allowing investment in underserved areas. Capital funding remains easy to cut when budgets are tight.
- Health insurers, brokers, and their shareholders
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Taxpayers and public budgets
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Fixed budgets can ration care: Global budgets cap spending.
- Black, Hispanic, and Native communities
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
- Rural residents
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
- Low- and middle-income households
- Racial, income, and geographic disparities: Access and outcomes differ by race, income, and location.
- Taxpayers and public budgets
- Under-investment in equipment and facilities: Restrained capital investment limits spending in the short term.
- Hospitals, clinics, and care organizations
- Low-value care and overtreatment: Per-service payments reward additional low-value care.
- Racial, income, and geographic disparities: They can select better-paying patients over those with lower-paying coverage.
- Drug and device makers
- Low-value care and overtreatment: They sell devices and tests used in low-value care.
- People with ongoing or specialist care needs
- Fixed budgets can ration care: Hospitals may slow elective procedures when demand exceeds fixed budgets.
- Multi-year capital commitments set by law
Where it has been tried
- Canada: Provinces fund hospital capital separately; Canada has fewer MRI scanners per person than the OECD average.Sources: OECD (2025)
- Maryland: Certificate-of-need review for major capital projects.