JUST ABOUT anyone familiar with the Canadian health-care system can agree on the problems it faces. Most realize the system has deep structural flaws; a large measure of consensus exists on the pressing need for reform and on the general direction it should take. And most observers agree that no such reform is likely.

The contrast between the gathering momentum for health-care reform and the political inertia in its way was a highlight of last week's Financial Post Conference in Halifax on ''Health Care in Canada: Can We Afford Unlimited Access?''

Certainly the old complaint of ''underfunding'' has been put to rest. As health economist Greg Stoddart of McMaster University said, nominal health spending has risen 12.4% per annum in the past 25 years, easily outstripping growth in the economy.

Nor is there much indication that patients are overburdening the system with frivolous demands for treatment. Said Stoddart: ''Labeling universal access as the villain leads us in all the wrong directions.''

But access is in jeopardy in Canada's public system. There are already months- long waiting lists for certain diagnostic equipment; other leading-edge technologies are simply unavailable.

If the problem is not lack of resources, or excessive demand, then clearly it is a case of poorly allocated resources. Where funds are being wasted is another question.

The basic outline of what is required is clear, however. Topping most conference speakers' lists was the need to put fewer people in institutions, to treat more people on an outpatient basis, and to put greater resources into home-care programs.

There is also a need to shift the balance of resources from curing to caring. Too many chronically ill patients are now occupying acute-care beds, because of a shortage of long-term care spaces.

Finally, everyone agreed the current system does not place enough emphasis on prevention, in the form of healthier lifestyles and ''wellness'' programs. The key to reform is to encourage more cost-effective methods, the conference was told. Paying doctors a salary, for example, rather than on a fee-for-service basis, discourages unnecessary treatments and tests. More broadly, doctors' authority over spending must be directly connected with responsibility for controlling costs.

The U.S. has had success in this regard with the Diagnosis Related Group system of payments to hospitals, as its co-originator, Yale University Professor of Public Health John Thompson, told the conference. The government reimburses the hospital a fixed amount for each medicare patient, according to the type of ailment, whatever the bundle of services provided during the hospital stay. The hospital's incentive is thus to provide only appropriate treatment and to keep the stay short.

Joseph Martin, partner-in-charge at Touche Ross Management Consultants, proposed offering direct incentives to doctors to keep hospital use down.

REVOLUTIONARY SYSTEM

The most revolutionary approach, now widespread in the U.S., is the use of Health Maintenance Organizations, as described by Vickery Stoughton, president of The Toronto Hospital. HMOs receive a flat fee, called a capitation fee, for each subscriber they enroll, in return for providing all treatment needed over a given period.

A general point, emphasized by more than one speaker, is that public finance of health care can and should be separated from public provision. There is, indeed, room within a public system for the use of the price signals of a private market In the current setup, however, allocative choices are ground through the gears of politics - not just the politics of government, but the politics of universities, hospitals, and professional groups.

When politics replaces the market as an allocative device, the result is interest group gridlock. Reform and innovation are the enemy of those with a stake in the status quo, who are unlikely to be moved by calls for ''political will and bureaucratic leadership,'' even from Ginette Rodger, executive director of the Canadian Nurses' Association.

For politicians in particular, there are no votes to be won in fiddling with health care. There are many to be lost, however.

That means any program for change must involve a sophisticated plan to win over or neutralize the interest groups opposed to it. It's not enough simply to persuade the general public. The stakeholders themselves must be given an interest in change.

''It has to be a lot more complex than a hope that dialogue will help,'' said Errol Pickering, director-general of the London-based International Hospital Federation. ''You have to have an intricate strategic political process, in the hopes of achieving some change in perhaps five to 10 years.''

One apparently successful example of this approach was provided by William Morrissey, deputy minister in New Brunswick's Board of Management department.

Politicians, he pointed out, have an interest in building big, expensive, impressive structures like hospitals. What is actually needed, however, is fewer hospitals and more home-care programs. Solution: call the home-care program a hospital - the ''Extramural Hospital.'' Then give it a board of directors, physician privileges, patient admission procedures, and, most importantly, a budget just like that of an ordinary hospital.

''You have to use the positive feelings of the traditional system to build support for alternative systems,'' he said.

All of the foregoing has been brought into sharper focus by the emergence of two potential system-breakers: most immediately AIDS , and, over the longer term, the growing numbers of the elderly.

Keynote speaker Robert Maxwell, the British press baron, counseled against panic and hysteria over AIDS, in the course of presenting rather an impressive case for panic and hysteria.

The World Health Organization's latest estimate puts the number of people infected worldwide at 10 million; 35,000 in the U.S.; more than 1,000 in Canada.

There is no cure; there is only prevention. That requires public education. Without much prompting, Maxwell was willing to say that ''it is a disgrace how little the Canadian government is doing in this area.''

Equally inadequate, according to closing speaker William Dalziel, head of Geriatrics at Ottawa Civic Hospital, is our treatment of the aged. Too many in institutions, too many wasting away in bed, too many having to wait to get into chronic-care hospitals - all of the problems with the health-care system in general are most acute with the old.