reforming Quebec’s Healthcare System: A New Era of Physician Responsibility

The Quebec government is embarking on a significant conversion of its healthcare system with the introduction of a new bill focused on enhancing access to medical services. Spearheaded by Minister of Health Christian Dubé, the legislation seeks to establish collective responsibility and accountability among physicians, aiming to ensure every Quebec resident receives timely and appropriate care. This initiative complements ongoing negotiations with doctors and builds upon previous efforts to improve healthcare accessibility.

Addressing Persistent Challenges in Healthcare Access

Despite various initiatives implemented since the unveiling of the health plan in March 2022—such as expanding the roles of nurse practitioners (NPs) and pharmacists, establishing NP-led clinics, and implementing the Guichet d’accès à la première ligne (GAP)—access to care remains a critical issue. While GAP has facilitated care for approximately 85% of the population, progress has plateaued, and individual registration for family doctors is declining. Moreover, wait times for specialist consultations and surgeries continue to be a concern. The new bill aims to address these challenges by fostering a revamped association of frontline services and promoting enhanced collaboration among healthcare professionals.

Key Components of the Proposed Legislation

The government’s strategy centers on a new remuneration model and the principle of collective physician responsibility. Here’s a breakdown of the key changes:

For Family Doctors:

• Patients with existing family doctors will retain their physicians.
• Existing collective registrations will be maintained.
• New registrations will be structured to promote access, with each patient affiliated with a care environment (e.g., GMF, CLSC) and assigned a reference doctor or professional group.

For Specialists:

• A territorial coverage plan will be established for each specialty, setting objectives to reduce waiting times for surgeries and consultations.

Revamping Physician Remuneration: A Shift towards Value-Based Care

Quebec’s traditional fee-for-service model, while effective in some areas, has shown limitations in ensuring widespread access to care. The proposed bill aims to simplify the remuneration structure for frontline family physicians, encouraging greater collaboration among healthcare professionals. This new model will be based on three core components:

1. Capitation: A fixed amount allocated collectively to doctors based on the number and complexity of their patients.
2. Fee-for-Service: Additional payments for specific services, including patient visits.
3. Hourly Rate: Compensation for time spent on patient care and administrative tasks.

This revised approach is designed to:

• Reduce the number of billable acts, streamlining paperwork and freeing up physician time.
• Shift towards a remuneration system that values patient management and availability.
• Recognize the time required for complex cases and administrative duties,while reducing overall administrative burden.

Reorganizing Care Delivery: Collective Responsibility and Performance Targets

The bill emphasizes a collective responsibility model, aiming to optimize workload distribution among healthcare professionals and leverage new tools to ensure the appropriateness of care. This reorganization seeks to create a more equitable system for physicians with significant workloads, incentivize increased availability, and improve overall care delivery.

Furthermore, the legislation introduces performance targets linked to remuneration.Up to 25% of a physician’s compensation will be contingent on meeting government-defined objectives, notably in areas of access and efficiency. These targets will apply to both family medicine and specialized medicine, aligning physician compensation with improved patient access.

Expert Insight

According to recent data from the Canadian Institute for Health Information (CIHI), wait times for specialist appointments and surgeries remain a significant challenge across Canada. Quebec’s initiative to address these issues through physician accountability and performance-based remuneration could serve as a model for other provinces facing similar healthcare access challenges.

Minister’s Outlook

We give ourselves the means so that each Quebecer has access to the care he needs, at the right time and by the good professional. We take a set of gestures that will improve access to our health network so that all Quebecers are taken care of by the summer of 2026. We fully recognize that it is indeed a significant change in culture. It will be necessary to ensure a management of sustained change. But we have to make this turn to ensure better care for patients and more effective use of available resources to successfully transform the health and social services network.
Christian Dubé, Minister of Health