Inequities in Fee-for-Service Remuneration Affecting Rheumatologists and Patient-Centered Care Across Canada: An Environmental Scan
Bibliographic record
Abstract
OBJECTIVE: Access to rheumatology services in Canada is becoming increasingly challenging because of the rising burden of rheumatic and musculoskeletal diseases in a rapidly growing population, and a workforce supply deficit that is projected to worsen in coming years. Specialist physician remuneration has been demonstrated to influence physician practices, thereby affecting access to health services and quality of care. Hence, we sought to compare fee-for-service remuneration structures across the provinces in Canada. METHODS: We performed an environmental scan to compare publicly funded billing codes and reimbursement fees for common rheumatology services across provinces in Canada as of July 2024. We further assessed whether reimbursement structures support person-centeredness (access to care dimension). RESULTS: Reimbursement for a new consultation in Canada ranges widely, from CAD $153.51 to CAD $239.57 per encounter. This is also apparent in follow-up visit payments ranging from CAD $65.55 to CAD $131.52. There is a disparity in billing rates available to reflect medically complex patients. Virtual care is also inconsistently funded across Canada. Multidisciplinary/interdisciplinary team-based care models are sparsely funded, with only British Columbia and Quebec having a dedicated billing code to fund nursing comanaged care. We identified large provincial variations in reimbursement fees for procedures, including injections/arthrocentesis and point-of-care ultrasonography. CONCLUSION: These findings raise health policy issues for funding equitable rheumatology services across Canada, prompting action to reduce pay disparities, remove restrictions/stipulations that impair person-centered care, and further optimize standardization of health services across Canada.
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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 | 0.005 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.012 |
| Science and technology studies | 0.006 | 0.003 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".