19. For the purposes of this Act, the Minister may, with the approval of the Government, enter into an agreement with the representative organizations of any class of health professionals.
An agreement may, in particular, provide that the remuneration of insured services will vary according to rules which apply to an activity, a type of activity or all activities of a health professional, or to the activities of a class of professionals or of a specialty. Such an agreement may also provide different methods of remuneration which include fee-for-service remuneration, flat-rate fees and salary. It may also provide, as compensation or reimbursement, for the payment of various amounts such as premiums, expenses or allowances.
After consulting the representative organizations of the health professionals concerned, the Minister shall determine by regulation the territories or places of practice that he considers to be understaffed. Such regulations may apply to all professionals in a territory or a place of practice situated therein or to part of them, depending on the nature of their activities.
An agreement may provide for a different remuneration for the provision of medical services in a territory or place of practice defined by a regulation made under the third paragraph.
In addition, it may provide for a different remuneration for physicians in the first years of practising their profession or specialty under the plan, according to the territory where they practise or the type of activities they carry on.
An agreement may provide for a different remuneration for physicians according to whether or not they are authorized to participate in the agreement pursuant to sections 360 and the following sections of the Act respecting health services and social services (chapter S-4.2) for all or part of their activities in the region. It may also provide for the terms and conditions of participation in such an agreement. The terms and conditions may provide, for the purposes of the first paragraph of section 360 of the Act respecting health services and social services, criteria permitting to determine whether a physician’s professional activity is carried on mainly in private facilities.
An agreement may, to ensure compliance with the regional medical staffing plans referred to in section 377 of the Act respecting health services and social services, provide for different remuneration for certain classes of health care professionals according to the location of their practice or the territory in which they exercise their activities.
Failing an agreement to determine the different remuneration referred to in the fourth and fifth paragraphs, the Government may fix the remuneration by a regulation which shall be in lieu of an agreement. It may likewise determine the number of years of a physician’s practice during which the different remuneration will apply, which shall not exceed three years. Any regulation which reduces the remuneration applicable to physicians during the first years of practising their profession or specialty under the plan applies only to physicians who begin practising their profession or specialty after the date of coming into force of the regulation.
Failing an agreement to determine the different remuneration and the terms and conditions of participation of a physician in an agreement referred to in the sixth paragraph, the Government may fix the remuneration by a regulation which shall be in lieu of an agreement, and determine the terms and conditions of participation referred to in the sixth paragraph. It may likewise determine the number of years during which the different remuneration will apply and the rules of equivalence enabling a physician having held a licence to practise for less than ten years to be released from participation in a particular medical activity, especially by reason of his heavy workload or the number of years spent in practice in a territory or place of practice determined in the regulation.
Failing an agreement to determine the different remuneration referred to in the seventh paragraph, the Government may fix the remuneration in a regulation to stand in lieu of the agreement.
The Minister may, on an experimental basis and for a determined period, enter into a special agreement with the professionals of a clinical department of an institution in order to apply a method of remuneration provided for in an agreement entered into under the first paragraph to those professionals. The agreement shall require beforehand the consent of the health professionals concerned, of the board of directors of the institution and of the organization representing the professionals concerned.
If the diminution of medical services in a territory endangers public health, the Minister may enter, for a fixed period of time, into a special agreement with a health professional in order to allow medical services to be adequately furnished in a facility maintained by an institution of that territory.
Any such agreement shall bind, as the case may be, the Board, the regional boards and the institutions.
The Minister must consult the Board or the regional board, the institution or the group of institutions which may be bound by name by an agreement or part of an agreement. The latter may submit to the Minister their recommendations as to methods of participation in reaching the agreement or any part thereof.
The Commission de la santé et de la sécurité du travail shall participate in the formulation of any part of such an agreement which deals with the services referred to in the tenth paragraph of section 3.
The provisions of the Labour Code (chapter C-27) and of the Act respecting labour standards (chapter N-1.1) do not apply to a health professional to whom an agreement made pursuant to this section applies who provides insured services in a facility maintained by or on behalf of an institution.
1970, c. 37, s. 15; 1970, c. 42, s. 17; 1973, c. 30, s. 6; 1973, c. 49, s. 45; 1974, c. 40, s. 8; 1979, c. 1, s. 14; 1981, c. 22, s. 4; 1984, c. 47, s. 15; 1985, c. 6, s. 489; 1992, c. 21, s. 375; 1991, c. 42, s. 564; 1994, c. 23, s. 7; 1998, c. 39, s. 177.