Physician remuneration methods for family physicians in Canada: Expected outcomes and lessons learned

Canada is a leader in experimenting with alternative, non fee for service provider remuneration methods; all jurisdictions have implemented salaries and payment models that blend fee for service with salary or capitation components. A series of qualitative interviews were held with 27 stakeholders in the Canadian health care system to assess the reasons and expectations behind the implementation of these payment methods for family physicians, as well as the extent to which objectives have been achieved. Results indicate that the main reasons are a need to recruit and retain primary care physicians to rural and remote regions of the country, and the desire to increase collaboration, care continuity, prevention and health promotion. The general perception is that positive results have been observed, but problems are not alleviated. Blended payments have had some positive effects on preventive care delivery, collaboration, and care continuity. Salaries have provided a stable, predictable, and high source of income for physicians, thereby improving recruitment and retention. The implementation of salaries, however, led to concerns with declining physician productivity, and has brought to light a need for improved measurement and monitoring systems.