this model maintains private providers, but payment comes directly from the government. insurance plans control costs by paying for limited services. in some instances, citizens can opt out of public insurance for private insurance plans. however, large public insurance programs provide the government with bargaining power, allowing them to drive down prices for certain services and medication. in canada, for instance, drug prices have been extensively lowered by the patented medicine prices review board. examples of this model can be found in canada, taiwan, and south korea.