TORONTO — A new study is calling for a central framework to help the provinces, hospitals and doctors determine where health-care funding should be spent. The study, by researchers at the University of Toronto's Joint Centre for Bioethics, also says that the public should have more input in health-care funding decisions in their own communities, said lead researcher Doug Martin.

"If we don't set priorities, we're (the health-care system) going to go broke," Martin said in an interview before the release of the study Sunday.

Canada currently has no central system or database that can share the experiences of health-care providers in various cities and provinces, the study says. Such a system could go a long way in channelling scarce health-care funding properly, adds the study, which is to be included in a new book set for release in May.

The book, titled Reasonable Rationing: International Experience of Priority Setting in Health Care (Open University Press), analyses how five countries, including Canada, go about deciding where health-care funding is spent, said Martin.

Martin said a priority-setting network is in place on a smaller scale in Toronto, and it's proved valuable in helping hospitals determine what's fair when deciding where funding should go.

For instance, he said, one hospital reported while going through its 2000-2001 planning meetings that there was no process in place for interest groups - like hospital staff and patients - to appeal any decisions about how the hospital's budget would be spent. So the following year, another Toronto hospital learned from that experience and developed an appeals process whereby all stakeholders, including the public, could have a say in whether funding was being spent properly.

Martin added that a national database, allowing health-care institutions across the country to share their experiences, could be developed in co-operation with the government-funded Canadian Institute for Health Information which operates at arm's length from Ottawa.

"We have to set priorities in a fair and sustainable way, and one of the ways to do that is to learn from each other," said Martin, an assistant professor in the University of Toronto's department of health policy, management and evaluation.

Keeping the health-care system afloat financially has been the focus of federal inquiries.

The study's researchers hope an inquiry led by former Saskatchewan premier Roy Romanow - who is set to come out with a report Nov. 28 - will deal with the question of how priorities should be set.

That should include sharing lessons at different levels of the health-care system across the country, and making the system "transparent" so every stakeholder knows what went into make spending decisions, said Peter Singer, director of the Joint Centre for Bioethics.

"Any long-term solution to health reform has to seriously deal with the issue of how priorities are set in the Canadian medicare system," he said.

About 70 per cent of the health-care system is publicly funded, yet there are still long waiting lists for care and concerns about where money is being spent, said Singer.

"Really what we're saying is we want to be able to focus public funding on the health-care services that are most important to Canadians," he said.

Singer said that could include, for example, putting more funding into supporting bypass surgery that can add years to a heart patient's life, rather than emphasizing funding for the development of medications that may only relieve symptoms of heart problems.