Act to Improve Access to Medical Services and Healthcare for the Population

Summary#

Bill 19 aims to amend Quebec's rules regarding access to medical services and patient care.

It notably proposes to:

• allow health professionals' compensation agreements to provide for capitation payment, meaning a fixed amount paid for the follow-up of an enrolled person, rather than payment for each service;
• allow for collective capitation payment, which could be distributed among professionals within the same team or practice setting;
• encourage the care of all insured individuals, improve access, and monitor the quality of services;
• consider up to 180,000 individuals deemed vulnerable by the Minister of Health as registered with a family physician when they are added to their patient list;
• repeal several provisions of the law adopted in 2025, including those that granted the government the power to set certain compensation methods for health professionals by regulation;
• modify certain rules regarding specialist physicians and their compensation agreements.

The bill mentions a target of 500,000 individual or collective registrations by June 30, 2026, including 180,000 vulnerable patients.

Several effective dates still need to be specified. The provided text also contains placeholders for dates that have not yet been filled in.

What This Means for You#

If you are a person without a family doctor, the bill could facilitate your registration with a physician or medical team, especially if you are considered vulnerable.

However, registration does not necessarily guarantee an immediate appointment or access to all services. The bill primarily seeks to change how physicians and teams are compensated and held accountable for patient follow-up.

For patients already registered, collective capitation payment could promote follow-up provided by multiple professionals within the same team. A physician could be compensated for care even if another team member directly provides certain services.

For physicians and other health professionals, the specific terms will depend on agreements made with their representative organizations. The bill does not itself set all amounts or conditions of compensation.

The minister could designate up to 180,000 individuals as vulnerable. The text does not specify, in the provided excerpt, the detailed criteria used for this designation.

Costs#

The bill does not present a complete estimate of its costs for patients, professionals, or the government.

However, it modifies certain amounts provided in the 2025 law. The indicated credits or amounts change as follows:

• from $5.0495 billion to $5.2182 billion;
• from $4.652 billion to $5.3431 billion;
• from $4.5786 billion to $5.2586 billion.

The text does not clearly specify, in the available excerpt, the distribution of these amounts or the portion that would be directly related to the new compensation measures.

For patients, no new direct payment is announced by the bill. Future costs will depend on compensation agreements and their implementation.

Supporters' Viewpoint#

Supporters might argue that the bill:

• provides more flexibility to compensate physicians and teams based on patient follow-up, rather than just the number of services provided;
• can improve continuity of care;
• promotes collaboration among physicians, nurses, and other professionals;
• pays special attention to vulnerable individuals;
• allows for monitoring access to services and their quality;
• replaces certain provisions deemed too prescriptive with agreements negotiated with professional representatives.

They might also argue that collective capitation payment encourages teams to accept and follow more patients, including those with complex needs.

Opponents' Viewpoint#

Opponents might fear that capitation payment could reduce the number of services offered to certain patients or create incentives to limit consultations. However, the actual effects will depend on the rules set out in the agreements.

They might also question the deemed registration of vulnerable individuals. A person could be considered registered without having directly chosen their physician or fully understanding the implications of this registration.

Others might feel that the bill gives too much latitude to the government and negotiating parties, as several important terms will be established later.

Finally, the numerous changes to the 2025 law and the still unspecified effective dates could make the application of the rules difficult to understand for patients and professionals.