OMA cautiously proposes "sharing" costs and responsibilities. (Commission On The Future Of Health Care).

TORONTO -- In a cautiously vague statement to the Romanow commission, the Ontario Medical Association is suggesting shared costs and opening for private insurers in medicare system and "shared costs and responsibilities" by patients.

Physicians should be the gatekeepers to care in family health networks, with the issues of nurse practitioners and information technology still to be resolved, the Ontario Medical Association told the Romanow Commission.

The OMA, together with the Ontario government, has pioneered restructuring of physician-led, primary care delivery through the development of the Ontario Family Health Network, said President Dr. Kenneth Sky. Effective and efficient health care delivery systems and infrastructure is one of three pillars of quality patient care, he said.

Adequate funding is the first, with the OMA calling for a reformed Canada Health Act that addresses sustainability of the health care system. The act should also include quality - through benchmarks for waiting times and access to diagnosis and treatment - and balanced accountability, Sky said.

While physicians are probably the most accountable professional group in the country, there is little scrutiny of the patient's use of the system to ensure wise spending, he noted.

Sky took issue with Romanow's view that there are four distinct perspectives Canadians hold of health care, suggesting that it is possible to find a solution that incorporates more public investment, shared costs and responsibilities, increased private choice and reorganization of service delivery.

The third key issue to address, Sky said, is the doctor shortage. The OMA would be releasing a position paper with solutions to the problem later in April, he said.