In Canada, the Provinces set the payment systems since health insurance is a provincial responsibility but they have to do so within certain requirements outlined by the Canadian Health Act (which is Federal legislation) and based on input from Health Canada which provides part of the funding, so the system varies from Province to Province.
The main system for payment is fee-for-service, in Ontario for example there are 8,000 different fee codes for everything from patient visits, writing a prescription, trauma care, and overtime hours.
The fee schedule for fee-for-service is negotiated between the Ontario Department of Health and the Ontario Medical Association which represents physicians.
Fee-for-service can create disincentives so Ontario and other provinces are working on different payment systems which mix fee-for-service with set base-salaries, plus incentives and special premiums, to encourage doctors to work in under-served areas.
The main system for payment is fee-for-service, in Ontario for example there are 8,000 different fee codes for everything from patient visits, writing a prescription, trauma care, and overtime hours.
The fee schedule for fee-for-service is negotiated between the Ontario Department of Health and the Ontario Medical Association which represents physicians.
Fee-for-service can create disincentives so Ontario and other provinces are working on different payment systems which mix fee-for-service with set base-salaries, plus incentives and special premiums, to encourage doctors to work in under-served areas.