Two-tier healthcare is a situation in which a basic government-provided healthcare system provides basic care, and a secondary tier of care exists for those who can pay for additional, better quality or faster access. Most countries have both publicly and privately funded healthcare, but the degree to which it creates a quality differential depends on the way the two systems are managed, funded, and regulated. Some publicly funded universal healthcare systems deliver excellent service and the private system tends to be small and not highly differentiated. In other, typically poorer countries, the public health system is underfunded and overstretched, offering opportunities for private companies to deliver better-quality, albeit more expensive coverage. Canada In Canada, patients have freedom with regard to which doctors and facilities they use. Under Canada's single-payer system, all Canadian citizens have the right to access healthcare services governed by provincial and territorial authorities. Within a person's province of residence, where they pay taxes, they are able to access any doctor they choose for most basic and essential healthcare services free of charge. Both referrals to specialists and hospital visits are covered. The decentralized, universal, publicly-funded health system is called Canadian Medicare. The federal government distributes funds to the provinces for healthcare, providing that the provinces have designed their systems to meet certain criteria, which they all do at present. Most people receiving care in Canada do not pay for their care apart from prescriptions and certain procedures that are not covered, such as visits to dentists, optometrists, and some others. The healthcare system is financed primarily through tax revenue. Canadians can choose to purchase health insurance to cover some or all of the healthcare services that are not covered by the government. Medical providers are generally paid fixed fees depending on the type of visit. The average doctor is paid $258,049 a year for the care provided. In situations where a doctor is being paid by their respective provincial healthcare system, the law bans the medical provider from charging patients to supplement their income from Medicare. Canada technically does not have a two-tiered healthcare system. However, some services in Canada covered not by government provided healthcare but instead by the private sector (dentistry, laser eye surgery, most cosmetic plastic surgeries), while most basic essential services are provided by the public healthcare systems, which are primarily administered by the country's 13 provinces and territories. Each province and territory