For the past 18 months, Roy Romanow has led a commission looking into the future of medicare in Canada. The commission is due to present its final report to the Prime Minister in late November.

The commission invited feedback from the public. The Commission has received over 1,900 formal submissions and abstracts from medical organizations, and more than 10,000 e-mails and letters from average Canadians.

Many of the recommendations have been presented before, during similar fact-finding missions; others are new ideas. Here's a look at a few of the recommendations presented to the commission.

The CMA speaks out

The Canadian Medical Association made 31 recommendations, most notably:

The establishment of a health care charter that spells out the rights and responsibilities of patients, health care professionals and governments. The charter would also establish minimum national standards for access to care.

The CMA also wants a national health commission to act as a watchdog -- an auditor-general of health -- to protect Canadian patients. This commission would be independent from government yet be funded by the public purse. A board composed of ordinary citizens and health professionals would oversee the commission.

The CMA would also like to see minimum national standards for access to care. They want a maximum waiting time for each type of major procedure or treatment. Guarantees would insure that if a patient has to wait too long for care, he or she would be allowed to go outside the province and even the country to receive care.

Electronic health records

Other groups have called for the creation of electronic health records. The records would eliminate unnecessary tests and the repetition of services. Before implementing the record, the federal government would need to define standards and rules for the collection, storage and use of such information.

The records would also make it easier for doctors to follow the health outcomes of specific techniques or courses of treatment, allowing physicians to learn from one another.

Some have recommended a national patient safety institute to prevent deadly medical errors. The aim of the institute would be to record medical mistakes, educate front-line medical workers and build safeguards to prevent similar errors.

National pharmacare

The Arthritis Society, among other groups, has asked for a national pharmacare system that would be managed and paid for by the federal government. It would replace the current provincial systems. The goals of the pharmacare plan would be to ensure that all Canadians receive equal access to medications, to improve prescribing appropriateness, and to reduce costs.

At a recent meeting in Vancouver, the premiers agreed for the need for a cross-country drug review system to streamline drug assessments and listings, and expedite the drug approval process. All new drugs would undergo one assessment, leading to a common recommendation on whether a new product should be covered under drug plans right across the country.

They also recommended the streamlining of the approval process for generic drugs, so that less expensive drugs are available more quickly.

Other groups want to see the establishment of a central drug purchasing agency to contract with Canadian pharmaceutical companies to supply generic copies of brand name drugs for non-commercial distribution.

Doctors and nurses

The Canadian Federation of Nurses Unions has called for a national nursing strategy, to recruit and hold on to more nurses, while improving their working conditions. The CFNU wants more nurses trained and more financial incentives to hold on to them. They even recommend forgiving student loans on a pro-rated basis for nurses who agree to work in hard-to-staff settings.

The College of Family Physicians of Canada says family physicians are working an average of 73 hours per week. They want to see more progressive physician recruitment and retention strategies, especially for underserviced communities. And they've called for tax incentives to encourage Canadian health professionals to return to Canada

Other physician groups have asked for a national database of doctors, nurses and technologists, and have pressed medical licensing bodies to simplify the protocol required of licensed Canadian physicians to practice anywhere in the country. At the same time, they recommend removing "inappropriate obstacles" impeding well-trained physicians from other parts of the world who choose to relocate in Canada.

Access to information

The Canadian Health Libraries Association says Canada needs a National Network of Libraries for Health (NNLH) so health practitioners everywhere in the country have the same access to the best information.

The Standing Senate Committee on Social Affairs, Science and Technology has called on the  federal government to develop a national health information portal, building on the success of the Canadian Health Network and the integration of provincial/regional portals. The portal would  ensure that rural, remote and aboriginal communities have access to information where the basic systems infrastructure is inadequate.

The Senate Committee also wants a strategy to encourage interchange of research scientists between government, academia and the private sector.

Finally, there have been calls for primary health care reform for aboriginal communitiese. A number of groups have pointed to the need for both finding health professionals to serve in native communities and training Aboriginals themselves in medicine.