Physician remuneration and effective clinical governance: a comparative analysis



Recent news articles in Québec's French-language media have drawn attention to a key issue: physician remuneration should measure up to the services provided to the Québec population.

In 2014, physician remuneration accounted for 21% of health care spending in Québec (ICIS, 2016). Between 2010 and 2015, the average gross income of physicians in Québec grew by 22% compared with an average of 8% across Canada (ICIS, 2015). In light of growing medical spending and changes in factors affecting health care systems (demographic, epidemiological, occupational, etc.), most industrialized countries are reviewing the way they pay physicians. An analysis of knowledge from scientific and grey literature dealing with physician remuneration identified a trend of change towards combinations of increasingly varied remuneration models, known as blended models.

There is a need to better understand and simplify the remuneration models by promoting transparency, consistency and accountability.

Québec is in line with this trend: while the fee-for-service model remains dominant, other forms of remuneration (salary, lump-sum fees, incentives, mixed remuneration, etc.) supplement the income of physicians. These blended models are aimed at enhancing physician integration and improving the quality and efficiency of care.

Given the recent introduction of these models, findings on their effects have not yet provided clear guidelines for application in Québec. With this in mind, there are two kinds of actions that should be considered. In the current remuneration context, there is a need to better understand and simplify the remuneration models in place by promoting transparency, consistency (e.g.: calculating the value of services and periodic review) and accountability (e.g.: quality and safety of care, cost control).

Innovation in physician remuneration policy calls for experimentation and a systematic assessment of innovative remuneration models in order to better serve priority clientele and to better meet the need for the management certain pathologies. To that end, is important to consider an integrated analysis of performance levers that could complement physician remuneration (clinical governance, professionalism). This would promote better coherence between the aims of the health care system and the preferences of the stakeholders concerned.

Main researcher

Jean-Louis Denis, Université de Montréal

Summary

Research report

Appendices

Call for proposals

Deposit of the research report: February 2017