wish to receive their full transfer payments from the federal government. The CHA does not allow charges to insured persons for insured services (defined as medically necessary care provided in hospitals or by physicians). Most provinces have responded through various prohibitions on such payments. Private-sector health care dollars, which has represented about 30% of total health expenditure, "consists primarily of health expenditures by households and private insurance firms". In 2018, private sector funding for health care, accounted for 31% of the total health expenditures. "includes primarily private insurance and household expenditures." The top categories of private sector expenditures account for 66% of this spending, and include pharmaceuticals, and professional services such as dental and vision care services. Only 10% of these services are paid for by the public sector. In 2017, 41% of private sector expenses were paid by private insurance companies. The amount of out-of-pocket spending represented 49% of private sector spending. A 2006 in-depth CBC report, the Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises. In 2006, most doctors do not receive an annual salary, but receive a fee per visit or service. According to Dr. Albert Schumacher, former president of the Canadian Medical Association, an "estimated 75% of Canadian health care services are delivered privately but funded publicly." Private clinics are permitted and are regulated by the provinces and territories. Private clinics can charge above the agreed-upon fee schedule if they are providing non-insured services or treating non-insured persons. This may include those eligible under automobile insurance or worker's compensation, in addition to those who are not Canadian residents), or providing non-insured services. This provision has been controversial among those seeking a greater role for private funding. Private health insurance In Canada private health insurances is mainly provided through employers. By 2016, "health care dollars from private insurance were $788 per capita" in 2016, which represents an annual growth rate of 6.4% from 1988 to 2016. According to a 2004 OECD report, 75% of Canadians had some form of supplementary private health insurance. In many provinces purchasing duplicate health insurance for care already covered by the government’s health insurance plan is prohibited. Out-of-pocket expenses From 1988 to 2016, the amount of out‑of‑pocket expenses paid by individuals had grown by about 4.6% annually. By 2016, it amounted to $972 per capita. Major healthcare expenses The highest health