加拿大对私人健康保险对受公共保险的医生和医院服务的作用的限制，在拥有普遍的、公共资助的医疗保健系统的国家中是独一无二的。然而，在加拿大，要求放松这些限制并建立一个平行的私人融资体系的压力越来越大。支持者认为，建立一个平行的私人融资系统将确保公共系统的可持续性(通过减少公共成本压力)，改善公共系统的可访问性(例如，通过减少等待时间)，并提高公共系统的质量(通过竞争)。反对平行私人融资的人认为，这将创造“两级”医疗，增加成本，损害公平性，降低质量和获得公共资助的医疗保健的机会，因为那些有经济能力(通常是最强烈的声音)的人会转向私人保险。在公共和私人财政并行系统的动态方面，澳大利亚为加拿大提供了一个特别有前途的研究案例。本文研究了澳大利亚在住院医院服务平行融资方面的经验，以提供以下方面的见解:(a)私人融资平行系统在降低公共系统的成本和等待时间方面的有效性;(b)在平行的公营和私营保险部门之间进行风险选择;(c)与引入和维持平行财政制度有关的财政再分配;和(d)与平行金融系统相关的更广泛的政治经济的动态。澳大利亚的经验为加拿大提供了一些教训，包括:(1)通过引进或扩大平行私营部门节省成本的潜力非常有限; (2) the introduction or expansion of a parallel private finance is unlikely to reduce wait times in the publicly financed system; (3) there is no simple way to regulate private insurers to pursue public objectives; (4) it is impossible to create an independent, isolated parallel system of private finance -- interactions between the public and private insurance sectors are complex and unavoidable; (5) quality plays a key role in driving the dynamics between the public and privately financed sectors; and (6) it is essential to articulate clear policy objectives for health care financing and to design public and private roles consistent with these objectives. Our overall conclusion is that the Australian experience provides a cautionary tale regarding the risks, costs and benefits of a parallel private system of health care finance.