Canadian physicians: the struggle with health reform.

The Canadian health system is now in an era of significant change. Decentralization, the changing role of government consumer movement and new views on health greatly affect physicians' relationships with patients, consumers and other health professionals, and will determine the governance and mandate of medical associations. While the Canada Health Act requires coverage of all medically necessary health services provided by hospitals and medical practiitioners, the understanding of the term medically necessary appears to be changing to include issues related to financial sustainability and scientific appropriateness. As goverments become interventionist in the health care system as a reaction to fiscal imperatives, their traditional role as funder and planner is changing as they begin in a more explicit manner, to manage the health care system and to engage in directly influencing patient management decision-making. These new directions will have a major influence on the practice of medicine in the 21st century.