"Canada is alone with perhaps North Korea and Cuba having a purely single payer general health care system."

We have a "10 provincial central payors and 3 territorial central payors, with a top up from the GoC to help cover some of the costs" system.  And there's hundreds of exempted or only partially subsidized treatments or medications, private providers, private insurers, coordinated coverage, extra-provincial billing, extra-national billing, quasi-governmental bodies, etc. in play.

We DO have a hybrid system, just not a particularly efficient one.