Private funding of health care has been restricted largely to health services and good which are considered supplementary to medically necessary services. Their operations are guided by community boards of trustees. If a hospital runs over budget, it is possible to get extra money from the government. Fee schedules are negotiated periodically between the provincial governments and medical associations. Using Medicare Canadians may visit any doctor they wish at any time when they can arrange an appointment, regardless of their level of income.
Patients can get a second opinion, or even a third.
There is no limitation on access to physician services at the individual patient level. Through self-governance and decentralization, the German health care system traditionally has operated almost independently of the government. The federal government through statute, sets parameters for the system such as caps on annual incomes of providers, but leaves practically all operational decisions to the sickness funds and associations representing providers. The German system prides itself on solidarity within the population to meet the needs of those less able to provide for themselves. While this is the intention of the German system, it has not always described reality.