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- Page navigation anchor for RE: Ensuring Adequate Capital Investment in Canadian Health CareRE: Ensuring Adequate Capital Investment in Canadian Health Care
The authors of this timely paper correctly note the linkages between capital investment and improved health care quality, so it is disappointing that their attention then wavers and slides back into the comfort of the familiar when it comes to considering new sources of capital. Canadian bond markets receive only a passing reference yet the operational innovation that we sorely need could be facilitated by the enhanced financial competence needed to access bond finance. Canadians deserve health care leaders whose financial and operational skills matter more than their connections to elected officials. Bond finance could bring both discipline in operations and enhanced capital access far more impactful than changing tax treatment of charitable giving.
Competing Interests: None declared.References
- Bijan Teja, Imtiaz Daniel, George H. Pink, et al. Ensuring adequate capital investment in Canadian health care. CMAJ 2020;192:E677-E683.
- Page navigation anchor for More research needed for health systems infrastructure fundingMore research needed for health systems infrastructure funding
We read with great interest Teja et al.’s analysis of capital spending in Canada’s public health care system.(1) There has been insufficient research into health sector capital financing, despite its clear significance to health system performance. We welcome this recent contribution in this under-researched area of health policy and health services planning.
First, we are not in disagreement that “capital investment has both varied more and declined in recent years, suggesting underinvestment and inequity in health care capital.” However, we have concerns with the analysis and the evidence presented to support the conclusions made by the authors.
The authors claim that “removing the capital gains tax on donations of real estate and or private company shares could stimulate a substantial increase in charitable giving among Canadians, including to charitable organizations raising money for health care capital expenditures.” No peer-reviewed literature is cited. We are also not aware of any literature that supports the idea that public health care systems would be well-served by relying increasingly on charitable donations. On the contrary, the evidence suggests that the performance of publicly financed systems is most likely to benefit from public – not private – finance.(2) It would seem, then, that the remedy is ensuring consistent public capital investment. One such mechanism might be for the federal government to require consistent capital spending plans f...
Show MoreCompeting Interests: Andrew Longhurst is employed by the Health Sciences Association of British Columbia.References
- Bijan Teja, Imtiaz Daniel, George H. Pink, et al. Ensuring adequate capital investment in Canadian health care. CMAJ 2020;192:E677-E683.
- Tuohy CH, Flood CM, Stabile M. How does private finance affect public health care systems? Marshaling the evidence from OECD nations. J Health Polit Policy Law. 2004;29(3):359–96.
- Boardman AE, Siemiatycki M, Vining AR. The theory and evidence concerning public-private partnerships in Canada and elsewhere. Calgary: School of Public Policy, University of Calgary; 2016.
- Whiteside H. Purchase for profit: public-private partnerships and Canada’s public health-care system. Toronto; 2015.
- Zuberi D. Cleaning Up: How Hospital Outsourcing Is Hurting Workers and Endangering Patients. Cornell University Press; 2013.