Cost shifting, inf which governments transfer the cost of certain heal
th care services to patients or private insurance companies, is increa
sing rapidly, and Dr. Christopher Carruthers thinks it will spell an e
nd to Canada's single-payer system, The signs are already there: the p
rivate sector is offering more services and employers are keeping a-cl
oser eye on the health care system as they begin to pay a bigger share
of the costs, The result, says Carruthers, is that government influen
ce is bound to diminish as the private sector tries to fill voids crea
ted by governments that are trying to live within their fiscal means.