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Quebec's Bill 106 Sparks Controversy: Linking Doctor Remuneration to Performance Targets
Fanny Levesque, Our Site
A contentious issue has arisen between the Legault government and medical professionals regarding Bill 106, which proposes linking up to 25% of a doctor's remuneration to collective performance indicators. This means that if the province's set targets are not met, a portion of their income will be withheld. This has fueled a heated debate, particularly as medical clinics have sent letters to patients warning that their access to health care could be affected by these changes. The College of Physicians has urged an immediate halt to these communications, deeming them misleading, but the Quebec Federation of Family Physicians (FMOQ) maintains its right to inform patients of the potential risks of the bill. Premier François Legault added to the discord on Thursday, asserting that the family doctors' union's actions were "irresponsible."
Both family and specialist doctors voice opposition to tying part of their income to meeting targets, given the current state of the healthcare network, with closed operating rooms and limited human resources. In addition, this remuneration model has sparked concern among experts. The expert committee appointed by the government to rethink access to first-line care did not recommend this approach, and the College of Physicians shares this view. Limiting income based on performance could even pose a threat to patients, according to its president, as it may foster a focus on quantity over quality of care.
The government's proposal includes several indicators, ranging from national targets to local and territorial targets at the clinic or regional level. For family doctors, targets include making 18 million appointment slots available annually, ensuring that 90% of vulnerable patients are affiliated with a family medicine clinic or group, and offering 20% of appointments Monday to Friday evenings. For specialists, targets include performing 99% of surgical interventions within a 12-month period and interpreting 95% of medical imaging exams within five days. These objectives are subject to negotiation and may be revised, but primarily consist of quantitative indicators measuring a volume of interventions or patients.
However, several experts have cautioned that the government is heading in the wrong direction. Joanne Castonguay, the Commissioner of Health and Well-being, contends that using volume indicators could reproduce the undesired effects of traditional fee-for-service financing, which the government hopes to avoid. Instead, she suggests focusing on qualitative performance indicators that emphasize the quality of care. This aligns with the recommendations of the expert committee on primary care and the Provincial Committee of Users. Castonguay is one of the few to support linking a portion of remuneration to performance objectives, but emphasizes that these should be based on "health and well-being results" and that clinics should have a say in their achievement.
References:[1] Fundamental questions about the link between doctor remuneration and performance targets: https://globalnews.ca/news/7910503/quebec-doctors-bill-106-fmoq/[2] Quebec's Bill 106: An Overview: https://www.cbc.ca/news/canada/montreal/quebec-doctors-bill-106-1.5931861[3] Quebec doctors worry about patient care as bill aims to link pay to performance: https://www.cbc.ca/news/canada/montreal/quebec-doctors-pay-performance-1.5989084[4] Bill 106 sparks debate: https://www.cbc.ca/news/canada/montreal/bill-106-debate-1.5931865[5] Experts, medical federations challenge Quebec's plan to link doctor pay to performance: https://montreal.ctvnews.ca/experts-medical-federations-challenge-quebec-s-plan-to-link-doctor-pay-to-performance-1.5275040
- Science experts and educational institutions are expressing concern over the proposed remuneration model for doctors in Quebec's Bill 106, fearing the potential negative impact on health and wellness.
- Recent reports of medical clinics informing patients about potential health care access issues due to changes brought about by Bill 106 have sparked debate in the realm of general news, medical-conditions, and health-and-wellness.
- As the discourse around Bill 106 continues to unfold in politics, some experts suggest a focus on qualitative performance indicators for doctors in the field of education and self-development, emphasizing quality of care over volume of interventions or patients.
