Thank you very much, Madam Chair.
I want to thank everyone for their presentations, but there are some things. I agree with everyone who talked about the fact that outcomes, efficiency, quality of care, and timeliness of care are all things we should be rewarding and creating incentives for as we go about building a system based on patient-centred care. Primary and community care models will keep patients out of hospitals, and this is all good.
There are a couple of ethical things that arise out of something Dr. Coyle said. I'm not agreeing or disagreeing with him; I just want to clarify this. There have to be some commercial considerations when you're looking at research. If a drug, a device, a new treatment, or a new way of delivering care has proven to be good, one would want to commercialize it and use it.
At the same time, what are we going to do about patients who cannot be kept out of hospitals? We cannot do prevention and promotion to keep them healthy, because they have certain diseases that are rare or that may or may not be genetic. Are we helping to treat those patients if all we do is look at the cost? Are we going to be denying patients who have rare diseases and are going to be costly to the system because there are a small number of these people and it's the only way to keep them alive? Are we going to suggest that we look at ways of deciding who should get what care, that we ration care for people who do not make up a large portion of the community?
I would like to have you clarify these things. I think they're very important. I agree with all of the things you've said, but there comes this flip side to it and this ethical model that one has to consider. To whom do we say, “Sorry, baby, there are only 20 of you in the country and we can't be bothered to keep you alive”? I know you're not saying that, but I'm saying that is a slippery slope. How do we deal with not going down the slippery slope but still look at evidence?