from private insurance and the remaining half is supplied by out-of-pocket payments. There is considerable variation across the provinces/territories as to the extent to which such costs as out of hospital prescription medications, assistive devices, physical therapy, long-term care, dental care and ambulance services are covered. According to a 2001 article in Annals of the Royal College of Physicians and Surgeons of Canada, applying a pharmacoeconomic perspective to analyze cost reduction, it has been shown that savings made by individual hospitals result in actual cost increases to the provinces. Healthcare spending by province The planning and funding of most publicly insured health services are the responsibility of provinces and territories. There is a regional variation in health system characteristics. Healthcare costs per capita vary across Canada with Quebec ($4,891) and British Columbia ($5,254) at the lowest level and Alberta ($6,072) and Newfoundland ($5,970) at the highest. Total health spending per resident varies from $7,378 in Newfoundland and Labrador to $6,321 in British Columbia. Public drug spending increased by 4.5% in 2016, driven largely by prescriptions for tumor necrosis factor alpha and hepatitis C drugs. According to a 2003 article by Lightman, "In-kind delivery in Canada is superior to the American market approach in its efficiency of delivery." In the US, 13.6 percent of GNP is used in medical care. By contrast, in Canada, only 9.5 percent of GNP is used on the Medicare system, "in part because there is no profit incentive for private insurers." Lightman also notes that the in-kind delivery system eliminates much of the advertising that is prominent in the US and the low overall administrative costs in the in-kind delivery system. Since there are no means tests and no bad-debt problems for doctors under the Canadian in-kind system, doctors billing and collection costs are reduced to almost zero. Public opinion According to a 2020 survey, 75% of Canadians "were proud of their health-care system." An August 31, 2020 PBS article comparing the American healthcare system to Canada's, cited the director of the University of Ottawa's Centre for Health Law, Policy and Ethics, Colleen Flood, who said that there was "no perfect health care system", and the "Canadian system is not without flaws." However, Canadians "feel grateful for what they have." At times, the complacency has resulted in Canadians not demanding for "better outcomes for lower costs". She said that, Canadians are "always relieved that at least