By NextBestFitUnder-investment in equipment and facilities
Centrally planned capital budgets tend to under-invest; Canada has far fewer MRI and CT units per person than the U.S.
Evidence
- OECD data show the U.S. with far more MRI/CT units per capita than Canada or the UK.Sources: OECD (2025)
Who's affected
Who is hurt
- People with ongoing or specialist care needs: Underinvestment in diagnostic equipment leaves them waiting for tests.
Who gains while it lasts
- Taxpayers and public budgets: Restrained capital investment limits spending in the short term.
Under your mix of paths
Paths that create or worsen it
Paths that fix or soften it
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Root causes
- Capital competes with operating spending
Related costs
Open questions
- Who decides where hospitals, ORs, and scanners are built?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Limit private equity ownership and require disclosurePrivate equity roll-ups in medicineChosen
Ownership restrictions reduce capital available to practices.
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
New buildings and major equipment are funded by a separate capital budget allocated by regional need, not from operating revenue.
- +Under-investment in equipment and facilities
- +Low-value care and overtreatment
- +Racial, income, and geographic disparities
- −Takes years, or money up front, before it pays off
- −Fixed budgets can ration care
Each payment includes a capital component; hospitals decide how to invest it.
- +Under-investment in equipment and facilities
- −Racial, income, and geographic disparities
- −Low-value care and overtreatment