Countries With National Health Insurance Make Health Care Available On The Basis Of Need Rather Than Ability To Pay.
Most people in Britain, Canada and other countries that ration health care believe that the wealthy, the powerful and the sophisticated move to the head of the rationing lines. Because government officials have little interest in verifying this fact, few formal studies exist. There is considerable evidence, however, that in the face of health care rationing those who can pay find other ways to obtain health care.
In response to severe rationing by waiting, both Britain and New Zealand have a growing market in private health insurance – where citizens willingly pay for coverage for private surgery, although they are theoretically entitled to "free" surgery in public hospitals. As a result, the privately insured pay for health care twice – through taxes and through insurance premiums.
In Britain, the number of people with private health insurance policies has more than doubled in the last ten years, currently totaling about 10 percent of the population with about one in every five elective surgeries performed in the private sector. 
In New Zealand, one-third of the population is covered by private health insurance, and private hospitals now perform 25 percent of all surgical procedures. 
Since Canada does not allow private health insurance, if Canadians go to the less than 1 percent of the private physicians or less than 5 percent of private hospitals, they must pay the full bill out-of-pocket.  An exception is thesmall number of outpatient surgery clinics operated by entrepreneurial physicians. Government will pay the surgeon's fee but not other costs. Canadians who receive cataract surgery on an outpatient basis, for example, must pay from $900 to $1,200 out of pocket.
In addition, Canadian citizens are increasingly entering the United States to get health care they cannot get at home. In some cases, the Canadian province pays the bill. In other cases, patients spend their own money.  In either event, patients must bear the costs of travel. For example:
About 100 Canadian heart patients go to the Cleveland clinic each year because they cannot get timely treatment in their own country. 
A volunteer organization, "Heartbeat Windsor," arranges for Ontario heart patients to get treatment at Detroit hospitals (which accept the Ontario rate as payment in full), and Alberta has indicated it will accept a similar arrangement. 
Because there is only one lithotripter in all of Ontario, many lithotripsy patients cross the border; at Buffalo General Hospital in New York, for example, half of the lithotripsy patients are Canadians. 
Because of the inadequate facilities in Canada, about half of the in vitro fertilization patients at the University of Washington Medical Center are Canadians, paying $5,000 out of pocket for each procedure. 
In general, the Ontario government will pay 75 percent of the standard U.S. hospital charges and the same physician's fee it would have paid had the service been provided in Ontario. Apparently many American hospitals and physicians believe they can make a profit at those rates. U.S. drug dependency centers are actually marketing their services to Canadian citizens. Although the number of Canadian patients who cross the border is small, it is growing: 
In 1990, the Ontario Health Insurance Plan paid about $214 million to U.S. doctors and hospitals – up 45 percent over the previous year.
Of that amount, 40 percent went to Florida, 9 percent to New York, 5 percent to Michigan and Minnesota and 4 percent to California.