>I don't know of a state where the citizens are *not* able to opt for private care if they so wish and can afford it.
>OTOH, they don't have to right to opt out of the state provided system and any contributions they are required to make towards the cost of the same.

For the most part, Canada would be that state.

Here, if you need significant treatment there are 3 options:

- the state-run system
- medical tourism (primarily to the US for the well-heeled)
- (rare) private clinic

My understanding is physicians are only allowed to work at private clinics and charge market rates if they are completely outside the state system. IOW they are not allowed any privileges at state hospitals or other facilities and can't work part-time in such.

It's a large investment to set up professional-grade facilities with private funding, with no guarantee that "if [they] build it, they will come". That expense and risk is a major barrier to entry for private clinics in Canada.

There is also opposition to any private care in Canada on ideological grounds. The main points are that any removal of care providers from the state system weakens it, and also that providers who were educated and trained in Canada were significantly subsidized, that investment being "lost" if the providers go private.

OTOH there is increasing recognition that a careful mix of public and private care can be more outcome- and cost-effective than the current Canadian system; several European systems (e.g. France) are often quoted. There is also high-level legal pressure being applied: http://en.wikipedia.org/wiki/Chaoulli_v._Quebec_%28Attorney_General%29

It seems absurd that in Canada, you can buy all the smokes, booze and lotto tickets you'd like, but you can't (for the most part) buy improved health services for major treatment.

And you're right with your second point, regardless of what you might pay abroad or at a Canadian private clinic, you still have to pay provincial Canadian health insurance fees - you can't opt out.