The health care industry in North America is large by any standard, and has been growinig at a rapid pace. Expenditures on health care in the United States have been estimated at 7.5 percent of the gross national product in 1970 and 10.6 percent in 1985; the corresponding percentages for Canada are 7.3 and 8.6.' The publicly funded shares are also large: in the early 1980s, the public sector accounted for more than two-fifths of total health care expenditures in the United States and almost three-quarters in Canada.2 It is therefore not surprising that health care policies and practices have been the subject of much debate in recent years. One topic of continuing concern is the role of government in the financing of health care.
