This third set of papers lives up to the developing reputation of HealthcarePapers as an exciting publication that addresses topics of current urgency in a very timely manner. This well thought-out policy analysis should catch the attention of all health policymakers and strategists - even the "armchair" variety. As Duncan Sinclair points out there is no shortage of opinions and views on what should happen to our healthcare system; there are plenty of views about what is wrong and plenty of views about what should be fixed.

It is not clear that more resources, more management, more doctors, more nurses, more of anything is what is needed or will actually produce change. I think we need a minimum understanding by federal and provincial ministers about what the issues are. Then a strategy must be developed, and urgently! The problem, as I see it, is that more resources will achieve little - the problem is that the design of the system is fundamentally flawed! Tinkering with the system is not enough. My experience at the Health Services Restructuring Commission in Ontario over the last two years basically reinforced my views that honouring the commitments to the key principles of the Canada Health Act - loved by all Canadians - can not be achieved without system redesign. This redesign should start with measures to enhance the health of the individual and the family. Next, it should move to the first call when medical care is required, i.e., the primary health care system.With this foundation in place, people will only move to other levels of care when absolutely necessary.

But, redesign is not enough. Financial and performance incentives must be put into place to trigger high-quality care at low costs. It can be done if the incentives are in place.

Yes, consumers want access to comprehensive services but what does that mean in today's environment? Surely not what it meant decades ago when medicare was being debated, and the goal was simply to ensure that each Canadian had access to a hospital bed and a doctor when medically necessary. I suggest that this issue of HealthcarePapers gets at the heart of Canadian values and provides an opportunity for us to rethink the design of health systems in Canada.

I call on all politicians to read these papers carefully. I call on all healthcare providers to not only read them but also to share them with colleagues and their political representatives! And, consumers should get the word out to everyone who might listen. This will make for constructive debate and then change will begin to take place.

I also encourage you to write to us with your comments and responses to this issue. Rethinking medicare is a topic we will return to as ideas and solutions evolve.

Read on . . .

P.S. The last two issues of HealthcarePapers were reprinted and distributed well beyond our original targets. Electronic and paper versions of this issue and previous issues are available by contacting Barbara Marshall at 416 864-9667. She can be reached by email at subscriptions@longwoods.com.

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