An appealing promise, but with no guarantee of results
The problem? Nothing in the current text provides any concrete guarantee that these patients will be followed up. Committees will be created, of course, but there is a glaring lack of specific indicators to measure performance. Yet it is on this still vague basis that the Legault government is drafting its bill, expected on February 28. This artistic vagueness prompted former Health Minister Christian Dubé to resign on December 18. He criticized the agreement for maintaining the status quo on governance while granting doctors a 17% pay increase.
The big shift in compensation… with many exit options
To adapt to the aging population, the payment method is changing. Is fee-for-service over? Not quite. The idea is to introduce « capitation »: doctors will receive a fixed amount per patient, which will now represent 50% of their compensation. The rest will be paid on a fee-for-service and hourly basis. François Legault presents this as a revolution that no other government has dared to undertake. But beware of the asterisks at the bottom of the page. According to our information, the list of doctors who can refuse this new system is as long as your arm. Are you over 60? Excluded, to avoid early retirement. Do you teach? Excluded. Do you work in a walk-in clinic? You’re also excluded. Even « young doctors » could say no, although no one yet knows how a « young doctor » is defined. Erin Strumpf, an expert at McGill University, is sounding the alarm: when given the choice, professionals logically opt for what pays the best and is the least restrictive. The risk? That it will cost taxpayers more without making it any easier for you to see a doctor.
Having a doctor « on paper » or having a real one?
Let’s get back to our 500,000 patients. How are we going to get there? Quebec is putting an additional $137 million on the table to oil the machine. Part of this ($49 million) is conditional on the goal being achieved. But don’t pop the champagne too soon. Of this half a million people, only the 180,000 most vulnerable patients (chronic illnesses, major problems) will have a designated doctor in a family medicine group (GMF), as Minister Sonia Bélanger assures us. And the others? They will have a « group registration. » Basically, you will be affiliated with a service (the Guichet d’accès à la première ligne), but not necessarily with a specific person. Medical sources fear the worst: lists artificially filled to receive bonuses, but patients who never get appointments. There are fears of assembly-line consultations or « phantom access. »
The government has provided for penalties (27 million deducted) if targets are not met, but again, the criteria for failure have not been defined. Damien Contandriopoulos, from the University of Victoria, points out that the technical challenge is immense for the RAMQ, whose computer systems are already struggling to keep up. Ultimately, the budget to pay our general practitioners will exceed $3.4 billion per year by 2028. It remains to be seen whether the service will keep pace with the bill.
According to the source: ici.radio-canada.ca Created by humans, assisted by AI.