expenditures. The proportion spent on hospitals and physicians has declined between 1975 and 2009 while the amount spent on pharmaceuticals has increased. Of the three biggest health care expenses, the amount spent on pharmaceuticals has increased the most. In 1997, the total price of drugs surpassed that of doctors. In 1975, the three biggest health costs were hospitals ($5.5B/44.7%), physicians ($1.8B/15.1%), and medications ($1.1B/8.8%). According to the April 2018 report entitled Pharmacare Now: Prescription Medicine Coverage for All Canadians issued by the House of Commons Standing Committee on Health "spending on medicines dispensed outside hospitals accounted for 85% of total drug expenditures in 2017." The CHA requires that public provincial and territorial health insurance policies must cover all "medicines used within the hospital setting...out‑of‑hospital drug expenditures are paid for by private insurance and individuals, as well as by provincial health insurance for certain population groups". Public provincial and territorial health insurance covers "43% of out‑of‑hospital medicine"; private insurance covers 35%; and the remainder, which represents 22% is paid by individuals out-of-pocket. Pharmaceutical costs are set at a global median by the government price controls. Physician services The third largest healthcare expenditure in Canada are physician services which represented 15.1% of the total in 2018. From 1997 through 2009, the proportion of total annual health expenditures spent on physicians declined. In 2007, physician services cost $21.5B representing 13.4% of total health expenditures. By 2009, that had increased to $26B. Number of physicians Canada, like its North American neighbor the United States, has a ratio of practising physicians to a population that is below the OECD average but a level of practising nurses that is higher than the OECD average, and below the US average in 2016. A record number of doctors was reported in 2012 with 75,142 physicians. The gross average salary was $328,000. Out of the gross amount, doctors pay for taxes, rent, staff salaries and equipment. Recent reports indicate that Canada may be heading toward an excess of doctors, though communities in rural, remote and northern regions, however, may still experience a shortage. Physician payment Basic services are provided by private doctors (since 2002 they have been allowed to incorporate), with the entire fee paid for by the government at the same rate. Most family doctors receive a fee per visit. These rates are negotiated between the provincial governments and the province's medical associations, usually on an annual basis.