Quebec Ties Doctor Pay to Access Targets

Summary#

• Bill 106 aims to improve access to medical care in Quebec by making clinics and doctors collectively responsible for taking charge of every insured person.

• It links doctors’ pay to the needs of the local population and to clear access targets.

• Every eligible person will be affiliated (linked) to a primary care practice near home. Family doctors in that practice share responsibility for your ongoing care.

• “Taking charge” becomes a covered service paid by capitation (a fixed amount per patient, adjusted by health needs).

• The Health Minister can set pay models by regulation, including how capitation works and how patient “vulnerability” levels are defined.

• Family doctors in clinics move to a mixed pay model: capitation + hourly pay + extra fees for some procedures.

• A new collective bonus (up to 25% on top of regular pay) rewards groups of doctors (family and specialists) for meeting access goals set nationally, by region, or locally.

• RAMQ will track who is affiliated to each practice and each person’s vulnerability level; clinics must name a representative and set rules for splitting payments.

• Penalties apply for misreporting diagnoses or misattributing services; fines can reach tens of thousands of dollars.

What it means for you#

• Patients

  • You will be affiliated to a nearby primary care practice. The practice is collectively responsible for your ongoing care, not just one doctor.
  • If you already had a family doctor, your file is converted: you are affiliated to that doctor’s practice, and that doctor remains your main follow-up where possible.
  • You can ask to change your affiliation. You can also be moved if you move away, are no longer eligible, the practice lacks capacity, or there is a loss of trust.
  • You cannot be charged for being “taken in charge.”
  • RAMQ will keep a record of your affiliated practice and your vulnerability level (based on diagnoses in your medical file). This affects how much your practice is paid, not your eligibility for care.
  • People in Cree and Nunavik territories are excluded from these new pay rules; other arrangements apply.

• Family doctors

  • In most clinics (private cabinets, CLSCs, and certain multidisciplinary sites), you move to a composed pay model: capitation + hourly pay + some fee-for-service acts. Some services may remain fee-for-service.
  • Capitation is paid to the practice for each affiliated patient, adjusted by vulnerability level. Doctors in the practice share this payment using agreed “split” rules.
  • You must designate a practice representative and keep practice registration with RAMQ up to date. If no split rules are filed, RAMQ splits based on each doctor’s share of services provided that quarter.
  • You cannot bill patients for “taking charge.” Wrong or inflated diagnosis codes can trigger administrative penalties.
  • Doctors still on a fixed-fee pay mode as of spring 2026 can remain on it until they switch.

• Medical specialists

  • You are eligible for a collective bonus tied to access goals (for example, shorter wait times). The bonus is calculated per service and scaled by whether goals are met.
  • You must include your practice’s identification number on claims; misattribution can trigger a 10% penalty on related payments.

• Clinics and practice groups

  • Must accept affiliated patients proportionate to capacity. The territorial family medicine department assigns patients quarterly, preferring proximity.
  • Must set internal rules to split collective capitation and bonus payments among doctors and name a representative to deal with RAMQ.
  • RAMQ can recover overpayments from the collective, and if needed from individual doctors based on what each received.

• Home care and long-term care (CHSLD)

  • Better coordination of medical services at home and in long-term care is required at the territorial level.

• System planning

  • Santé Québec must create national coverage plans for each specialty, updated every two years, to direct services where they are most needed.

• Timing

  • Some parts start October 2025; the capitation/mixed pay model for family doctors and related rules begin around April 2026. Transition rules convert current enrollments to the new affiliations.

Expenses#

No publicly available information.

Proponents' View#

• Ensures everyone has a “home” in primary care, which should reduce ER visits and help people get timely appointments.
• Pays doctors for looking after a population, not just for individual visits, which can support prevention and chronic disease follow-up.
• Ties part of pay to clear, published access targets, creating accountability and focus on results.
• Encourages team-based care in clinics, making it easier to share work and extend hours.
• Uses national and regional coverage plans to direct specialist services to priority areas and places with staffing gaps.
• Gives government tools to adjust pay models faster by regulation as needs change.

Opponents' View#

• Forced affiliation may feel like reduced patient choice; people could be assigned to clinics or doctors they did not pick.
• Paying per patient may discourage longer or complex visits if not balanced well; clinics might prefer healthier patients.
• Using diagnosis data to set vulnerability could pressure “upcoding” and raises privacy concerns about who can see what.
• New reporting, representatives, and payment-splitting rules add administrative work and risk payment disputes.
• Collective bonuses could be gamed, create uneven rewards across regions, or penalize areas with severe shortages beyond doctors’ control.
• Unclear total cost and impact on physician recruitment; some doctors may resist or leave certain settings if the model feels too restrictive.