Canada, Germany, Japan, France, and the United States have market-oriented health systems with varying degrees of government regulation and management. Great Britain has also considered introducing economic incentives into its limited profitable markets among the public hospitals and allowing private physicians to deliver medical care within the National Health Service. The enactment of the 1993 amendments to the Health Insurance Act of the Russian Federation thus introduces Russia to the health care debate, which is intensely preoccupying Western governments.