subsidized). Some systems combine elements of these four funding mechanisms. In contrast to the standard usage of the term, some writers describe all publicly administered systems as "single-payer plans", and others have described any system of healthcare which intends to cover the entire population, such as voucher plans, as "single-payer plans", although these usages generally do not meet strict definitions of the term. Regions with single-payer systems Several nations worldwide have single-payer health insurance programs. These programs generally provide some form of universal health care, which is implemented in a variety of ways. In some cases doctors are employed and hospitals are run by the government, such as in the UK or Spain. Alternatively, the government may purchase healthcare services from outside organizations, such as the approach taken in Canada. Canada Healthcare in Canada is delivered through a publicly funded health care system, which is mostly free at the point of use and has most services provided by private entities. The system was established by the provisions of the Canada Health Act of 1984. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual's health, which remains confidential between a person and their physician. Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province, every doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. In general, costs are paid through funding from income taxes. A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care. There is no need for a variety of plans because virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, and there are no lifetime limits or exclusions for pre-existing conditions. Pharmaceutical