That sounds like one for me.
The Canadian Medical Association went out over the last year and spoke to Canadians about what they wanted from their health care system. We spoke to about 2,400 people face-to-face, and we had another 4,000 comments online. We produced a variety of documents as a result of that, and the last one was Voices into Action, which was a kind of narrative of what we'd heard.
The message was very clear from Canadians. They want a system that was free of gaps, free of silos. They don't want this crazy situation, which evolved from the forties and fifties, where we were an acute-based system. We dealt with acute illnesses, and health care was delivered by physicians by and large in institutions. That's how medicare was set up, and that's how it's funded. That's the Canada Health Act.
They suggested this needed to be looked at from several points of view. We distilled down the principles from this, with support from the Canadian Nurses Association and a whole variety of other groups. I think there were 60 other stakeholder groups that signed on with us.
Essentially, they looked at it from the point of view of better value for money, better health care, and a better patient experience. If you actually sit down and say, well, if you've got a chronic illness, what is the system going to look like if you need it, there are lots of good examples scattered around Canada and North America and the globe. The catch is getting that information and measuring it in terms of outcomes.
At the end of the day, it's the outcomes that matter. The difficulty is that we've got a huge outcome gap. We are fifth in spending among OECD countries in terms of percentage of GDP, and if you look at outcomes as they define them, we're 27th or 28th. We've got this huge gap. The question may not be so much about how much we spend as much as how we spend it.
In answer to your question, again, there's no simple answer. But if you start to look at the system from the point of view of a person with chronic disease, it won't take long to find a way of describing a system that doesn't mean 30% of your old people never get to see the doctor because they can't get out of the house—they don't drive, there's no one to get them there—and they wait until they fall over and have to call an ambulance.
You can describe a system because of its faults. What you need to do is say, well, what would happen if there were no faults here? How would you recognize it? That's a very difficult thing to do at a table like this, but if you go to the 85-year-old who can only afford to take her diabetic pills every second day, you can start to see where the holes are, and the holes are sometimes individuals.