Inequities in Fee-for-Service Remuneration Affecting Rheumatologists and Patient-Centered Care Across Canada: An...

Area of Science:

• Health Services Research
• Rheumatology
• Health Policy

Background:

• Rheumatic and musculoskeletal diseases are increasing in Canada, straining rheumatology services.
• A projected worsening workforce deficit exacerbates access challenges.
• Physician remuneration significantly influences healthcare access and quality.

Purpose of the Study:

• To compare fee-for-service remuneration structures for rheumatology services across Canadian provinces.
• To assess if reimbursement structures support person-centered care, specifically access to care.

Main Methods:

• An environmental scan of publicly funded billing codes and reimbursement fees for common rheumatology services was conducted.
• Data was collected for all Canadian provinces as of July 2024.
• Reimbursement structures were analyzed for their support of person-centered care.

Main Results:

• Significant provincial variations exist in reimbursement fees for new consultations (CAD $153.51–$239.57) and follow-up visits (CAD $65.55–$131.52).
• Disparities in billing rates for complex patients, inconsistent virtual care funding, and sparse support for multidisciplinary care models were identified.
• Provincial differences were also noted for procedures like injections and point-of-care ultrasonography.

Conclusions:

• Provincial disparities in rheumatology service funding raise significant health policy concerns.
• Recommendations include reducing pay disparities, removing barriers to person-centered care, and optimizing service standardization across Canada.