Improving Access to Family Medicine in Quebec through Quotas and Numerical Targets

Abstract

Despite various health reforms over the last 20 years, access to primary care remained stagnant in Québec, and in 2014 the province had the highest proportion of residents in Canada without a family physician.In November 2014, the Québec Minister of Health and Social Services introduced Bill 20, An Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation.Bill 20 aimed to increase access to family medicine through a system of quotas of registered patients and penalties for family physicians.Health system user support groups and the governmental advisory group on women's rights supported Bill 20's approach to ensure the rights of system users to access family physicians.However, the union of general practitioners was strongly against the bill due to the clash between the minister's reliance on numbers and the realities of family practice.The union of general practitioners entered negotiations with the minister and while Bill 20 was legalized in 2015, it was agreed that family physicians would be excused from the bill as long as they reached two targets at the end of December 2017: 1) 85% of Québecers must have a family doctor and 2) family doctors must ensure the patients registered to them see them, and not other doctors, 80% of the time.The targets were not met at the end of December 2017 but the quota system in Bill 20 has yet to be implemented. Improving Access to Family Medicine in QuébecLee & Quesnel-Vallée la fin de décembre 2017, le système de quotas prévu dans le projet de loi 20 n'a pas encore été mis en œuvre. Key Messages• Family physicians strongly opposed Bill 20, notably due to its focus on performance metrics that did not sufficiently factor in the structural constraints on family practice in Québec.• As of 25 August 2019, Bill 20's system of quotas and penalties for family physicians has yet to come into effect.• It has been suggested that Bill 20's proposal to establish patient quotas for family physicians may have served as a negotiation tool for Québec's Minister of Health and Social Services. Messages-clés• Les médecins de famille se sont fortement opposés au projet de loi 20, notamment en raison de l'emphase mise sur les indicateurs de performance qui ne tenaient pas suffisamment compte des contraintes structurelles de la pratique de médecine de famille au Québec.• En date du 25 septembre 2019, le système de quotas et de pénalités pour les médecins de famille proposé dans la loi 20 n'est toujours pas encore entré en vigueur.• D'aucuns ont suggéré que la proposition du projet de loi 20 visant à établir des quotas de patients pour les médecins de famille n'était en fait qu'un outil de négociation pour le ministre de la Santé et des Services sociaux du Québec.