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Canada
The Canadian system for health care delivery can be described as a mixed system because it is possible to have completely private health care with the patient paying the provider. However, most Canadian health care is provided through the single-payer model. Each province in Canada has the constitutional option to opt out of this system, although none have to date. All physician, hospital, pharmaceutical, and clinic fees are set and paid for by the government. A health care provider cannot charge more than the government fee, even if the patient is not covered by the public system or is from another country, unless the provider opts out of the system altogether. Other health care expenses such as dentistry and optometry are wholly private-sector operations. Each person who enrolls in the program is given a health care card, much like the Medicare card in the United States. All people have the same plan (http://www.hc-sc.gc.ca).

In recent years, American citizens have increasingly gone to Canada to purchase prescription drugs and be treated for certain illnesses. U.S. citizens take advantage of the high quality and lower cost of Canadian health care. Canadians also come to the United States for elective surgeries such as hip and heart. Canadians travel to the United States for health care for specialized procedures not available in Canada and in some cases to avoid long waiting times.

History
The early French settlers founded Catholic hospitals in the 1800s. Health care in Canada was private until 1946. At that time, the province of Saskatchewan introduced universal health care coverage. Over the next 10 years, the remaining nine provinces introduced similar coverage. In 1957, the Hospital and Diagnostic Services Act was passed through which the federal government paid 50 percent of costs of the health care programs in all 10 provinces. In 1966, the Medical Care Act was passed that instituted the universal coverage countrywide. The Canada Health Act was passed in 1984 that prohibited extra user fees and extra physician billing fees. The Canadian system, which blends universal health coverage with private-sector fee-for-service, is often seen as a model for U.S. health care reform in current and future discussions.

Delivery
The majority of health care in Canada (75%) is funded publicly and delivered privately. The private-sector spending is about 30 percent of the total, primarily for services not covered by Canadian Medicare such as dentistry, optometry, some prescription drugs, cosmetic surgery, and for, in some provinces, priority access to health care services. Canadians may also purchase supplementary private health insurance for these services; about 65 percent of the population has this coverage.

The actual delivery of services is the responsibility of the provinces and territories. Although privately funded, most of the services are provided by private enterprises. Most physicians do not receive a salary, but are paid on a fee-for-service basis. They in turn pay their staff, much like private practice physicians in the United States. The role of the federal government is to:

Provide the funds to deliver the services to the provinces

Set and administer the principles of the national health care system

Deliver services to specific special groups—veterans, First Nation Peoples, and the Inuit people

Provide public health, health protection programs, and health care research

Both Canadian citizens and health care providers report high approval ratings for this system (Health Canada http://www.hc-sc.gc.ca).

Statistics
In 2012, Canada spent 9.8 percent of GDP on health care, or U.S. $4,045 per capita. Of that, approximately 70 percent was government expenditure, according to the World Health Organization (WHO) (Canada http://www.who.int/countries/can).