The Romanow report is expected to reject user fees for basic medical services but endorse "smart cards" to deter abuse of the health care system.

Canadian Press

OTTAWA — The Romanow report is expected to reject user fees for basic medical services but endorse "smart cards" to deter abuse of the health care system. Commissioner Roy Romanow is putting the finishing touches on his report, to be released next month, but officials say there are many clues as to what he will say.

Commission spokesman Michel Amar noted the strong consensus against user fees which emerged in public-opinion workshops held across Canada.

There was overwhelming support for a universal, single-tier system where all citizens can get care they need regardless of their ability to pay.

"The report is going to be evidence-based and it's going to reflect what Canadians want," said Amar in an interview.

"What people said was they wanted the core social contract at the heart of medicare protected."

In workshops conducted by the Canadian Policy Research Networks in June, about 500 representative Canadians were confronted with the basic options in health reform.

Once the participants had considered the pros and cons they rejected user fees, in part because they felt such fees would prevent poor people from seeking care.

"If you're sick you go to a doctor, if your doctor says you have a problem they fix you up - people don't even want to talk about user fees for that basic stuff," said Amar.

"If you're talking about extras - new things in the system - there's scope to talk about it in that."

There was also a strong consensus that efficiency gains from an electronic health card or "smart card" would outweigh privacy concerns.

Electronic health records have been promoted mainly as a way to improve efficiency, since doctors could quickly retrieve a patient's medical history without asking a lot of questions.

But participants in workshops were more interested in filtering out frivolous use of the system.

"Everybody talked about somebody's mother-in-law who's seen 20 specialists and everybody knew somebody who was going to doctors because they had nothing better to do," said Amar.

"People just couldn't bring themselves to say user fees because they also looked at the other consequences that might bring.

"That's where you had the issue of smart cards out of the blue in every session."

Under the Inquiries Act, which sets the rules for royal commissions, it is a criminal offence to breach secrecy, and the Romanow commission has not produced any leaks to date.

But Romanow and his staff allowed to "foreshadow" his findings in general terms.

"There will be a lot on accountability and tracking things and a lot also on improving the system," said Amar.

"Improving the system will take account of what everybody knows is required, some investments in . . . electronic patient records and things of that sort."