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

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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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