The Canadian system is a mix of private and public, with a mix of national and provincial funding, some national standards (tied to funding), and provincial jurisdiction.
For procedures covered by provincial health programs, doctors in private practice (GPs, at least some surgeons) give the service to the patient and then bill the government for that amount. For services that aren't covered by provincial health programs, GPs/surgeons bill the patient.
Provincial health care programs cover anything medically necessary. My general understanding is that you cannot pay to have a service done which is covered by a provincial health program. The intent is to prevent the establishment of a two-tier health care system.
It's probably less complicated than the US system, but it's still complicated.
