The Romanow commission released a study yesterday calling for a new national charter for medicare that would determine what medical services will be publicly financed.

The study -- which may be a sneak preview of what former Saskatchewan premier Roy Romanow recommends in his report to the federal government this fall -- argues that a new charter, or "constitution," should spell out commonly accepted principles or values for Canadian society in regard to health care.

This values-based approach, the study says, stands in contrast to both a market-driven view of how to deliver health care and a goal-oriented system. The study also predicts failure for Alberta's planned experiment to allow an expert panel to decide what services will not be covered by medicare.

A national agreement on principles would make it easier for provinces to set priorities for medicare, health economists Alan Shiell of the University of Calgary and Gavin Mooney of the Curtin University of Technology in Perth, Australia, say in the study. The charter would also help the public to hold provincial and federal governments accountable if they fail to deliver services.

The study assumes Canadians will want an ethical approach to the allocation of health-care dollars.

Canadians may have to make tradeoffs between efficiency and equity in the ranking of principles.

As an example, Prof. Shiell said a new but expensive type of operation to fix a club foot might benefit a child for decades to come.

That same operation might improve the quality of life for an elderly person only marginally and for a short time.

If efficiency were the higher priority, the elderly person might not get the operation.

But if equity trumped efficiency, the older person would have the same claim to the surgery under medicare as the child.

Equity generally means a need for more public funding, the study says.

The study is one of several prepared for Mr. Romanow on the future of medicare, a hot-button political issue that pits provinces and Ottawa against each other in ways akin to the great Meech Lake constitutional debates a decade ago.

Prof. Shiell, a newcomer to Canada, said if he had known about the Meech Lake controversy he might have used a word other than constitution.

The researchers use "constitution" as an economic term to distinguish a principles-based allocation of public money from either a market or a goal-oriented approach -- which might involve trying to wipe out a particular disease.

For years, the federal government has set out the "pillars" of medicare in broad terms -- public administration, universality, portability, comprehensiveness and accessibility.

The study says: "It is timely to revisit the aspirations that Canadians have for their health-care system to ascertain the tradeoffs that they are prepared to make."

The researchers suggest that the state of Western Australia might provide a model for comprehensive public deliberations on health care.

It is holding a health-care "constitutional convention" later this year.

The study curtly dismisses Alberta's plan to have experts "delist" certain services from medicare based on experience in other countries. "The panel has not yet been established, but there is no reason to believe that it will succeed where previous attempts to delist services have not."

The researchers did not give reasons why attempts to delist services have failed.