For a long time, doctors in Quebec have been paid by the traditional fee-for-service system, a payment mechanism that drew heavy criticism. It was blamed for inciting doctors to increase the volume of non-necessary billable services, and for discouraging certain productive activities that are not remunerated on a fee-for-service basis, such as teaching and administration. Iniquities were also observed, depending on the nature of the tasks performed by the doctors. In 1999, the Ministry of Health and Social Services introduced an optional mixed compensation system for specialist physicians, combining a base wage (or per diem) for every half-day worked in a medical establishment with a partial fee for services provided.
What impact did this new payment system have on the specialists' practice choices? The Équipe de recherche sur l'économie de la fiscalité et des programmes sociaux (Research Team on the Economy of Taxation and Social Programs), directed by Bernard Fortin from Université Laval, sought to answer this question by analyzing a Collège des médecins du Québec survey and administrative data from the Régie de l'assurance maladie du Québec.
The results of this study are highly instructive and were in fact published in the Journal of Health Economics, the most respected international journal in this field. They show a considerable impact of payment mechanism on medical practice. The mixed compensation system resulted in a reduction in the number of medical services performed by doctors and a reduction in the hours of work spent on seeing patients, while increasing the average time spent with each patient. Teaching and administrative tasks, included in the base wage rather than fee-for-service, also increased. However, the time spent on research, an activity that is not remunerated under the mixed compensation system, decreased by close to 15%! These results are of great interest to the Ministry of Health and Social Services.
Équipe de recherche sur l'économie de la fiscalité et des programmes sociaux
Bernard Fortin, Université Laval
- Charles Bellemare, Université Laval
- Yann Bramoullé, Université Laval
- Jean-Yves Duclos, Université Laval
- Sabine Kroger, Université Laval
- Guy Lacroix, Université Laval
- Bruce Stephen Shearer, Université Laval