Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country." Canadian Medicare provides coverage for approximately 70 percent of Canadians' healthcare needs, and the remaining 30 percent is paid for through the private sector. The 30 percent typically relates to services not covered or only partially covered by Medicare, such as prescription drugs, eye care, and dentistry. Approximately 65 to 75 percent of Canadians have some form of supplementary health insurance related to the aforementioned reasons; many receive it through their employers or use secondary social service programs related to extended coverage for families receiving social assistance or vulnerable demographics, such as seniors, minors, and those with disabilities. According to the Canadian Institute for Health Information (CIHI), by 2019, Canada's aging population represents an increase in healthcare costs of approximately one percent a year, which is a modest increase. In a 2020 Statistics Canada Canadian Perspectives Survey Series (CPSS), 69 percent of Canadians self-reported that they had excellent or very good physical health—an improvement from 60 percent in 2018. In 2019, 80 percent of Canadian adults self-reported having at least one major risk factor for chronic disease; smoking, physical inactivity, unhealthy eating or excessive alcohol use. Canada has one of the highest rates of adult obesity among Organisation for Economic Co-operation and Development (OECD) countries attributing to approximately 2.7 million cases of diabetes (types 1 and 2 combined). Four chronic diseases—cancer (leading cause of death), cardiovascular diseases, respiratory diseases and diabetes account for 65 percent of deaths in Canada. In 2021, the Canadian Institute for Health Information reported that healthcare spending reached $308billion, or 12.7 percent of Canada's GDP for that year. Canada's per-capita spending on health expenditures ranked 4th among health-care systems in the OECD. Canada has performed close to, or above the average on the majority of OECD health indicators since the early 2000s, and consistently ranks above the average on OECD indicators for wait-times and access to care, while receiving average scores for quality of care and use of resources. The Commonwealth Funds 2021