Doctor Pay Shifts to Patient Enrollment

Summary#

• This Quebec bill changes how doctors can be paid and how patients are registered, to improve access to medical care.
• It promotes team-based care and capitation (a fixed payment per enrolled patient), with a focus on enrolling more people, especially those who are vulnerable.
• It also cleans up parts of a 2025 law, updates some budget limits, and adds rules for clearer patient billing when fees are charged.

Key changes:

• Allows payment agreements to include capitation, including “collective” capitation shared across a care team.
• Requires future agreements with doctors to prioritize enrolling and following all insured people, improving access, and tracking access and quality.
• Lets the Health Minister designate up to 180,000 vulnerable insured people; once a family doctor adds them to their panel, they are treated as officially registered right away (applies from the bill’s tabling date).
• Adds a rule that, when a patient is charged, they must get a detailed bill; a regulation will set what the bill must include.
• Repeals many parts of the 2025 access law, including powers that let government set doctors’ pay by regulation; narrows certain representation rules to medical specialists.
• Increases three statutory health spending amounts set in the 2025 law.

What it means for you#

• Patients without a family doctor

  • The bill aims to boost enrollments, with a public target to add 500,000 people by June 30, 2026, including 180,000 vulnerable patients.
  • Doctors and teams can be paid to take you on and follow your care, not only for each visit. This is meant to support faster assignment and ongoing follow-up.

• Vulnerable patients

  • If the Minister designates you as vulnerable and a family doctor adds you to their panel, you are counted as registered right away. This rule applies retroactively from the day the bill was tabled.
  • Intended to speed up your access to organized, continuous care.

• People who pay any fees

  • If you are asked to pay, you must receive a detailed bill that shows required information. The exact details will be set by regulation.

• Family doctors (omnipraticiens)

  • Your pay can include capitation for enrolled patients, not just fee-for-service.
  • You can be paid even when another professional in your clinic (like a nurse or other health worker) provides the service, if the agreement sets collective capitation and you have taken responsibility for the patient’s care.

• Clinics and care teams

  • Collective capitation can be shared among team members according to agreed rules, encouraging team-based care and task sharing.
  • Agreements must include measures to track access and quality, which may mean more reporting.

• Medical specialists

  • Some governance and representation rules in the 2025 law are refocused on specialists. This is more about how negotiations are organized than day-to-day practice.

Expenses#

Estimated fiscal impact: the bill raises three spending amounts set in existing law by about CAD $1.54 billion in total; actual spending will depend on future agreements and enrollment.

• Raises three statutory amounts in the 2025 law:
  • From about $5.05B to $5.22B (+$0.17B).
  • From about $4.65B to $5.34B (+$0.69B).
  • From about $4.58B to $5.26B (+$0.68B).
• Shifts in payment models (more capitation, team-based care) could change how funds flow to clinics and doctors. The exact annual cost depends on negotiated agreements and how many patients are enrolled.

Proponents' View#

• Capitation supports continuous, team-based care and encourages doctors to take responsibility for patients over time, not just per visit.
• The bill is designed to speed up registrations, with a clear target of 500,000 more people—especially 180,000 vulnerable patients—by mid‑2026.
• Collective capitation lets nurses and other professionals handle appropriate care, freeing up doctors for more complex needs and reducing wait times.
• Requiring detailed bills when patients are charged improves transparency and protects patients.
• Setting principles to measure access and quality builds accountability into future agreements.
• Removing broad regulation-making powers over physician pay may improve collaboration by relying on negotiated agreements.

Opponents' View#

• Capitation can create a risk of under-service if providers are paid the same regardless of how much care a patient needs, unless monitoring is strong.
• Paying doctors when others deliver the service could weaken individual accountability for patient experience and outcomes.
• Increasing statutory spending amounts raises concerns about total costs and budget pressure.
• Letting the Minister decide who counts as “vulnerable” could be seen as opaque or uneven across regions.
• Repealing powers that let the government quickly set pay rules by regulation may reduce flexibility to fix access problems if agreements stall.