Canada

Provinces actually cap what a doctor can charge the system. Family doctors basically have to run a business and bill the insurance plan of their province, and there are limits to how much they can charge per year. This keeps salaries lower than in the private sector, which can charge some provinces much more for the same services. It is a big part of the drive for doctors to go private. Many doctors are also expected to do walk-in clinic and ER hours, or to supervise new doctors in their province as well, but I don't know if that applies to the private ones. I hear that the waning supply of public doctors makes it harder to train new doctors in their residency years. Canada has been aggressively growing its population through immigration for the last decade, but hasn't addressed the doctor supply problem, so this is reaching a breaking point for the health care system. Ideally they would be attracting doctors and nurses to come to Canada as part of that immigration, which they try to do, but then they want them to take equivalencies which often amount to going through med school all over again. Without having the people to train them. And to have them pay for it while starting out in a new country with a high cost of living. So the system keeps salaries low and supply low, and they set up rules to trap doctors in their province so they can't escape it.

Both.