CMA call for 5 year funding, optimal use of private sector. (Romanow Commission).

OTTAWA -- The family physician should be the central provider and co-ordinator of publicly funded medical services in a system based on three pillars: a Canadian Health Charter, a Canadian Health Commission, and a renewed federal legislative framework, says the Canadian Medical Association (CMA).

Medicare emerged from the 1990s bent but not broken, largely due to the efforts of health professionals, the association told the Romanow Commission in June. Many decisions regarding the health care system have been made by governments without meaningful input from health professionals, the CMA said in its second submission to the commission.

It proposed three "pillars of sustainability" on which to reconstruct health care. A Canadian Health Charter would reaffirm the Medicare social contract, acknowledge the ongoing roles of governments in coordination and health planning and set out accessibility and portability rights and responsibilities of Canadians as well as the rights and responsibilities of governments, providers and patients.

Compliance with the charter would be monitored by the second pillar, an arm's-length Canadian Health Commission that would report annually and act as an advisory body to the Conference of the Federal-Provincial-Territorial Ministers of Health.

Both these pillars would be included in a revised Canada Health Act, which would also contain a broader definition of core services and allow for certain "service charges."

In terms of funding, the CMA called for a federal contribution that is locked-in for a period of five years, with an escalator tied to a three-year moving average of per capita GDP, rising to a target of 50% of provincial/territorial per capita health spending for core services. It also said the federal government should create special purpose, one-time funds totalling $2.5 billion over five years for health human resources planning, capital infrastructure, information technology and an accessibility fund.

Governments and regional health authorities should make significant efforts to secure input from practising physicians at all levels of health care decision-making, the association said. Other recommendations included:

* creation of a basket of core services, with no individual being denied essential care because of his or her financial situation;

* legislative changes to permit at least some core services to be "cost-shared" under uniform terms and conditions in all provinces and territories;

* creation of regional centres of excellence housing specialized services;

* "optimal" use of the private sector to deliver publicly funded health care services;

* recognition and support of the voluntary sector in funding and delivery of health care;

* support for informal caregivers through the tax system.