Canadian versus USA health care

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The Canadian healthcare system is funded primarily by tax dollars. The federal government
makes cash transfers to the provinces, but the provinces may levy their own taxes to help
defray the costs. Alberta and British Columbia require a health insurance premium, and other
provinces have instituted employer payroll taxes
Healthcare providers are predominantly private, but are funded by public monies via
provincial budgets. Hospital systems are largely private non-profit organizations with their
own governance structures (usually supervised by a community board or trustees) that receive an annual global operating budget from the provinces .
Physicians are mostly in private practice and remunerated on a fee-for-service basis (with an
imposed cap to prevent excessive utilization and costs) by the provincial health plan However, physicians that choose to opt out of the system cannot procure any public
monies, and are forbidden from billing above negotiated "Schedule of Benefits" pricing
which the "opted in" physicians are subject to. In other words, private physicians cannot bill
above the fee schedules for medicare physicians. Therefore, opting out is risky for physicians
and uptake is low.
Like other nations experiencing limitless demand, an ageing population and the costly
advance of medical technology, Canada has faced pressure to control health expenditure. It
has done so through explicit rationing.
Set up in 1989, the Canadian Co-ordinating Office for Health Technology Assessment is the
Canadian predecessor to our NICE, charged with exactly the same brief and, it seems,
carrying out its function in the same way. For example, in the case of new cancer treatment,
the latest pharmaceuticals (such as visudyne for macular degeneration), and high-tech
diagnostic tests, Canadian governments simply reduce their expenses by limiting the service.
Such a method ...