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.

Keywords

• primary health care
• health services accessibility
• general practitioners
• negotiating