Increasing Remuneration for Publicly Covered Eye Examinations in Québec
Bibliographic record
Abstract
In Canada, fees for publicly covered health services are negotiated between professional associations and provincial governments, usually for multi-year periods. Whereas almost all services provided by physicians are publicly covered, some professions, such as optometrists, serve both publicly and privately paying patients. For these professions, the gap between what they are paid for both types of patients looms large in their negotiation with the government. Moreover, they can threaten to walk out and refuse to treat publicly covered patients altogether, which increases their bargaining power vis-à-vis the government. The failed negotiation between optometrists and the Québec government between 2015 and 2018, and its resolution in 2018 is therefore a case study that offers valuable insights about the relationships between public payers and professions in a context where publicly covered services are only a portion of the profession’s income. Amid stalled negotiations, thousands of optometrists announced they would collectively opt out of the public system. However, this move was blocked by the Québec government via a ministerial decree which was then legally challenged by the Québec Association of Optometrists. The escalation of this dispute attracted considerable media coverage, garnered public interest, and mounted pressure on the Québec government. Ultimately, an agreement on an updated remuneration was reached ahead of the court date, and the new fees came into effect in August 2018. Au Canada, les tarifs des services de santé couverts par le système public sont négociés entre les associations professionnelles et les gouvernements provinciaux, généralement pour des périodes pluriannuelles. Alors que la quasi-totalité des services fournis par les médecins sont couverts par le système public, certaines professions, comme les optométristes, s’adressent à la fois à des patients bénéficiant d’une couverture publique et à des patients bénéficiant d’une couverture privée. Pour ces professions, la différence entre ce qu’elles sont payées pour les deux types de patients représente un contrainte considérable dans leurs négociations avec le gouvernement. En outre, les membres de ces professions peuvent menacer de quitter l’accord et de refuser de traiter les patients couverts par le système public, ce qui accroît leur pouvoir de négociation vis-à-vis du gouvernement. L’échec des négociations entre les optométristes et le gouvernement du Québec entre 2015 et 2018, suivi d’une résolution en 2018, est donc une étude de cas qui offre des indications très utiles sur les relations entre les payeurs publics et les professions dans un contexte où les services couverts par le système public ne représentent qu’une partie des revenus de la profession. Face à l’impasse des négociations, des milliers d’optométristes ont annoncé qu’ils se retireraient collectivement du système public. Toutefois, cette décision a été bloquée par le gouvernement du Québec au moyen d’un décret ministériel qui a ensuite été contesté juridiquement par l’Association des optométristes du Québec. L’escalade de ce conflit a attiré une couverture médiatique considérable, a suscité l’intérêt du public et a fait monter la pression sur le gouvernement du Québec. Finalement, un accord sur une rémunération actualisée a été conclu avant la date du procès, et les nouveaux honoraires sont entrés en vigueur en août 2018.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.006 | 0.002 |
| Scholarly communication | 0.004 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".