Reform Without Results? Quebec Still Struggles to Deliver Primary Care

December 16, 2025 – After more than two decades of reform, Quebec’s primary care system continues to deliver some of the poorest access outcomes in Canada, despite rising physician numbers, significant public investment, and repeated structural changes. These reforms have failed to address the root causes of the crisis and, without sweeping structural changes, access and continuity of care will continue to deteriorate, according to a new report by the C.D. Howe Institute.

In “The Quebec Primary Care Conundrum: Good Intentions, Persistent Problems,” Tingting Zhang shows that coercive policies, restrictive working conditions, and misaligned incentives have made family medicine increasingly unattractive to new physicians while limiting existing doctors’ capacity to deliver comprehensive primary care. “Quebec has some of the highest physician compensation in the country and more family doctors per capita than Ontario, yet access remains among the worst in Canada,” says Zhang. “The problem isn’t the number of doctors – it’s how the system is structured.”

The report highlights that nearly one-quarter of Quebecers still lack a regular primary care provider, and emergency rooms continue to absorb millions of visits for conditions that could be treated in community settings. Requirements that family physicians cover mandatory hospital shifts, combined with regional staffing plans that restrict where and how they can practice, have diverted physician time away from primary care. At the same time, team-based models have stalled due to fee-for-service incentives that discourage task-sharing and limit the effective use of nurse practitioners, pharmacists, and other healthcare professionals.

While recent legislative reforms like Bill 2 aim to expand access, they continue to rely on a “stick” approach that, based on past results, is unlikely to succeed.

Addressing Quebec’s primary care challenges requires coordinated structural reform. The province needs a central allocation architecture that defines responsibility, funding, equity and outcomes, while leaving care model design to local teams. Quebec has repeatedly done the opposite: it centralizes model design while leaving allocation fragmented and reactive. This is why reforms fail despite good intentions.

Transformation also requires reducing mandatory hospital work, adopting blended payments grounded in risk-adjusted capitation, fully integrating non-physician providers into teams, and strengthening accountability through performance measurement.

“Quebec has enormous potential to improve access by freeing up physician time, strengthening interdisciplinary teams, and aligning incentives with patient needs,” Zhang says. “Incremental tweaks will not solve this crisis. Without bigger changes, Quebec risks deeper access gaps, higher costs, and worsening outcomes for patients.”

Read the Full Report

For more information, contact: Tingting Zhang, Policy Analyst, C.D. Howe Institute; Raquel Schneider, Communications Officer, C.D. Howe Institute, 647-805-3918, rschneider@cdhowe.org.

The C.D. Howe Institute is an independent not-for-profit research institute whose mission is to raise living standards by fostering economically sound public policies. Widely considered to be Canada’s most influential think tank, the Institute is a trusted source of essential policy intelligence, distinguished by research that is nonpartisan, evidence-based and subject to definitive expert review.

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