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Problems with the health system in Ontario. Reform, reconstruction or deterioration? The need of Ontario's doctors to communicate through advertising with the public about the social contract and its impact on users of medicare. Hospital closures. What the future health care system could look like. The role of technology. Analogy between the health care system and private industry: a mutual focus on the customer. Changing profile of the patient. A view of the health care system as ever-changing and evolving. An outline of how current changes could be better facilitated.