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BACKGROUND: In all Canadian provinces, physicians can decide to either bill the provincial public system (opt in) or work privately and bill patients directly (opt out). We hypothesized that 2 policy events were associated with an increase in physicians opting out in Quebec. METHODS: The 2 policy events of interest were the 2005 Supreme Court of Canada ruling on Chaoulli v. Quebec and a regulatory clampdown forbidding double billing that was implemented by Quebec's government in 2017. We used interrupted time-series analyses of the Quebec government's yearly list of physicians who chose to opt out from 1994 to 2019 to analyze the relation between these events and physician billing status. RESULTS: The number of family physicians who opted out increased from 9 in 1994 to 347 in 2019. Opting out increased after the Chaoulli ruling, and our analysis suggested that between 2005 and 2019, 284 more family physicians opted out than if pre-Chaoulli trends had continued. The number of specialist physicians who opted out rose from 23 in 1994 to 150 in 2019. Our analysis suggested that an additional 69 specialist physicians opted out after the 2017 clampdown on double billing than previous trends would have predicted. INTERPRETATION: We found that the number of physicians who opted out increased in Quebec, and increases after 2 policy actions suggest an association with these policy interventions. Opting out decisions are likely important inputs into decision-making by physicians, which, in turn may influence the provision of publicly funded health care., In all Canadian provinces, most physicians work as part of a private business. Whether they are solo practitioners or part of larger group practices, physicians can bill the provincial public [...]

In 2020, British Columbia (BC) opened four pilot Nurse Practitioner Primary Care Clinics (NP-PCCs) to improve primary care access. The aim of this economic evaluation is to compare the average cost of care provided by Nurse Practitioners (NPs) working in BC’s NP-PCCs to what it would have cost the government to have physicians provide equivalent care. Comparisons were made to both the Fee-For-Service (FFS) model and BC’s new Longitudinal Family Physician (LFP) model. The analyses relied on administrative data, mostly from the Medical Services Plan (MSP) and Chronic Disease Registry (CDR) via BC’s Health Data Platform. Results show the cost of NPs providing care in the NP-PCCs is slightly lower than what it would cost to provide similar care in medical clinics staffed by physicians paid through the LFP model. This suggests that the NP-PCC model is an efficient approach to increase accessibility to primary care services in BC and should be considered for expansion across the province.

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Malgré l’offre de soins de santé mentale dans les soins primaires, la fragmentation des soins de santé mentale et physique demeure. Cet article analyse des modèles de prise en charge qui permettraient une globalité des soins, et fonde ses résultats sur 7 études de cas d’équipes multidisciplinaires reposant sur une pratique infirmière élargie au Québec, ainsi que sur des entrevues avec des professionnels de la santé (n = 51). Les résultats démontrent que les rôles demeurent cloisonnés suivant une dichotomie santé mentale et physique, et ce, malgré la composition multidisciplinaire des équipes. Ils indiquent également l’existence d’un rapport inversement proportionnel entre la complexité des situations de soins et le nombre de professionnels impliqués.

The COVID pandemic was an acute test of public health capacities worldwide. Many will hail the successes obtained and stress the importance of the discipline. On the contrary, this commentary defends the idea that the COVID pandemic response forced public health to enter in a Faustian bargain with governments and realpolitik that threatens the very core of the discipline’s principles.

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Public health is critical to a healthy, fair, and sustainable society. Realizing this vision requires imagining a public health community that can maintain its foundational core while adapting and responding to contemporary imperatives such as entrenched inequities and ecological degradation. In this commentary, we reflect on what tomorrow’s public health might look like, from the point of view of our collective experiences as researchers in Canada who are part of an Applied Public Health Chairs program designed to support “innovative population health research that improves health equity for citizens in Canada and around the world.” We view applied public health research as sitting at the intersection of core principles for population and public health: namely sustainability, equity, and effectiveness. We further identify three attributes of a robust applied public health research community that we argue are necessary to permit contribution to those principles: researcher autonomy, sustained intersectoral research capacity, and a critical perspective on the research-practice-policy interface. Our intention is to catalyze further discussion and debate about why and how public health matters today and tomorrow, and the role of applied public health research therein.

The article “Why public health matters today and tomorrow: the role of applied public health research,” written by Lindsay McLaren et al., was originally published Online First without Open Access.

The article reports on the role of occupational therapists as change agents in terms of optimizing access to health-care services.