Health care 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.[2] It is guided by the provisions of the Canada Health Act of 1984.[3] 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 his or her physician.[4] Canada's provincially based Medicare systems are cost-effective partly because of their administrative simplicity. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses health care to be involved in billing and reclaim. Private health expenditure accounts for 30% of health care financing.[5] The Canada Health Act does not cover prescription drugs, home care or long-term care, prescription glasses or dental care, which means most Canadians pay out-of-pocket for these services or rely on private insurance.[4] Provinces provide partial coverage for some of these items for vulnerable populations (children, those living in poverty and seniors).[4] Limited coverage is provided for mental health care.Competitive practices such as advertising are kept to a minimum, thus maximizing the percentage of revenues that go directly towards care. In general, costs are paid through funding from income taxes. In British Columbia, taxation-based funding is supplemented by a fixed monthly premium which is waived or reduced for those on low incomes.[6] There are no deductibles on basic health care and co-pays are extremely low or non-existent (supplemental insurance such as Fair Pharmacare may have deductibles, depending on income). In general, user fees are not permitted by the Canada Health Act, though some physicans get around this by charging annual fees for services which include non-essential health options, or items which are not covered by the public plan, such as doctors notes, prescription refills over the phone.[4]