Quebec Guarantees a Primary Care Home

Summary#

• This Québec law aims to give every eligible person a home for primary care and to improve access to medical services. It shifts how doctors are paid, adds group bonuses for hitting access targets, and sets rules to keep services running during disputes.
• Key changes:
  • Every eligible person will be affiliated to a local practice (clinic, CLSC, or other group setting). Family doctors in that setting are responsible for follow‑up; nurse practitioners can also provide care.
  • The government can set pay models by regulation. Family doctors get a capitation payment (per patient, per quarter), adjusted for a person’s health “vulnerability” level, plus other pay elements during a transition.
  • A collective bonus of up to 15% of doctor pay is tied to access and quality goals (like ER wait times, surgical delays, appointment supply). Bonuses are calculated for national, territorial, or local doctor “collectivities.”
  • Limits on fees charged to insured patients: the government can cap what non‑participating doctors may bill, no “pay for privileged access,” and a detailed invoice must be provided for any payment.
  • New tools to ensure continuity: the minister can require weekly schedules in select settings, stop concerted actions that cut access, and apply penalties if rules are broken.
  • Current doctor agreements are extended to March 31, 2028, with set budget envelopes and adjusted tariffs.

What it means for you#

• Residents and patients

  • You will be affiliated to a nearby primary care setting starting in 2026. This gives you a “home base” for follow‑up and coordination.
  • You can ask to change your affiliation. You may be de‑affiliated if you move out of Québec or in other defined cases.
  • Care remains covered. Doctors cannot charge you for being “taken on” and cannot sell faster access beyond set limits. If any payment is requested, you must receive a detailed invoice.
  • ER and surgery targets are built into doctor bonuses. Over time, the plan aims to shorten triage‑to‑doctor times in ERs, reduce total time spent in ER, speed up imaging reads, and cut waits for specialist consults and surgeries.
  • Hospitals and health networks may use your name and contact info to ask for donations, but you can opt out.

• Family doctors and primary care teams

  • You collectively receive capitation for affiliated patients, scaled by vulnerability level (higher needs, higher rate). Doctors in a practice can set rules to divide capitation among themselves.
  • During the transition (from April 1, 2026, in offices, CLSCs, and some group settings), pay is a composite: capitation + hourly rate + add‑ons for certain services (including in‑person, telehealth, home visits, group visits, and inter‑professional consults).
  • You must send diagnoses used to determine patient vulnerability to RAMQ. False or missing data can lead to repayments, administrative penalties, or fines.
  • Practice leaders may receive “tokens” that RAMQ pays out for defined administrative tasks (e.g., running family medicine departments or GMFs).

• Medical specialists

  • A collective bonus applies to specialties too, with targets for consult waits, surgical delays, imaging interpretation times, and coverage plans by specialty.
  • Telehealth services are paid by time with set per‑5‑minute rates when provided from Québec.

• Clinics, hospitals, and Santé Québec

  • Santé Québec sets quarterly intake numbers by vulnerability level for each practice setting and must ensure follow‑through obligations for affiliated patients.
  • Departments must prioritize affiliating more vulnerable people through 2026, and allocate people in proportion to each practice’s capacity.
  • Hospitals will follow new national coverage plans by specialty (first versions due in 2026).

• Universities with medical faculties

  • Must keep teaching and research activities going for students. Grants can be partially withheld if they fail to take appropriate steps.

Expenses#

Estimated fiscal impact: the law rebalances existing physician compensation within set envelopes and ties up to 15% to group performance; it does not add open‑ended spending beyond published budgets through 2027–28.

• Family medicine remuneration envelopes (approximate):
  • 2025–26: $2.748B
  • 2026–27: $2.243B
  • 2027–28: $2.281B
• Specialist remuneration envelopes (approximate):
  • 2025–26: $5.050B
  • 2026–27: $4.652B
  • 2027–28: $4.579B
• Base medical tariffs drop to about 86.96% of 2025 levels as of Jan 1, 2026; part of pay shifts to collective bonuses.
• One‑time bonuses in 2027 and 2028 pay $5,000–$11,000 per physician if province‑wide targets are met.

Proponents' View#

• Guarantees everyone a primary care “home,” which should improve continuity and reduce ER pressure.
• Pays family doctors for taking responsibility for a panel of patients, not just for individual visits, rewarding prevention and follow‑up.
• Group bonuses align all doctors toward concrete goals: faster ER triage, shorter surgeries and imaging waits, and more family medicine appointments.
• Stronger tools keep services running and protect medical training during disputes.
• Clear limits on what patients can be charged and a required detailed invoice protect insured people from surprise bills.
• Uses data to match resources to patient needs by vulnerability level.

Opponents' View#

• Heavy penalties and government‑set schedules may feel coercive, harm morale, and reduce professional autonomy.
• The new capitation and hourly rates could cut income for some doctors, especially with the initial tariff reduction.
• Vulnerability scoring relies on administrative data; errors or under‑reporting could misclassify patients and affect funding.
• Collective bonuses and complex formulas may push metric‑chasing over individualized care and add paperwork.
• Automatic affiliation could assign people to practices they did not choose; changing affiliation may be slow in some areas.
• Allowing donation solicitations using patient contact info, even with opt‑out, may be unwelcome to some.