On 25 October 2025, Quebec enacted Bill 2: An Act mainly to establish collective responsibility with respect to improvement of access to medical services and to ensure continuity of provision of those services. The legislation introduces a fundamental shift in how physicians are remunerated, marking a move away from the traditional fee-for-service model toward a capitation model. The reform aims to improve access to primary care, reduce wait times and enhance accountability within the province’s publicly funded health system.
Under Bill 2, family physicians will receive a fixed, prospective payment per patient assigned to their practice, rather than being reimbursed per visit or service delivered. This payment will be risk-adjusted based on patient vulnerability, using four categories: healthy, minor chronic condition, moderate chronic condition, and major chronic condition. Physicians caring for patients with higher health needs will therefore receive higher capitation rates. The legislation also introduces performance-based targets tied to clinical outcomes and access measures, including the percentage of surgeries completed within prescribed timelines. A portion of physician compensation will depend on collective success in meeting these government-defined objectives.
The bill further establishes mechanisms for monitoring compliance and imposes penalties on any concerted actions that disrupt the provision of medical services, such as coordinated slowdowns or refusals to take on patients. These provisions seek to discourage physician migration to the private sector or other provinces, a growing concern amid workforce shortages.
Criticism and concerns from physicians and associations
According to Professor Olivier Jacques of the Université de Montréal’s Department of Health Policy, Management and Evaluation, the Bill’s attention to patient vulnerability represents an important advancement. However, he cautions that capitation alone may not sufficiently incentivize physicians to see more patients or increase their availability, underscoring the need for complementary measures that address practice organization and resource support.
La Fédération des médecins omnipraticiens du Québec (FMOQ), representing the province’s general practitioners, has strongly criticized the legislation. The FMOQ argues that performance-based remuneration cannot resolve the systemic issues driving inequitable access to care, including the administrative burden on physicians, regional disparities and inadequate primary care infrastructure. The federation warns that the new accountability model risks worsening the physician shortage, noting that more than 100 doctors have reportedly begun the process of applying for licensure in other provinces, including Ontario and New Brunswick. Critics also contend that by focusing heavily on numerical targets, the reform may inadvertently prioritize quantity of care over quality and continuity, while further eroding physician morale and well-being.
Opponents have also expressed concern that Bill 2 disregards physicians’ broader professional contributions, such as teaching, mentoring, research and leadership within health institutions. Both the federations representing general practitioners and medical specialists have signalled their intent to legally challenge the legislation, arguing it infringes on professional autonomy and individual liberties.
Implementation challenges and future outlook
The provisions of Bill 2 are scheduled to take effect on 1 January 2026. As implementation approaches, its success will depend not only on the financial mechanics of capitation but also on the system’s capacity to support primary care teams, manage performance fairly and sustain physician engagement amid a strained health workforce.