Context/Background: Centralized waiting lists are increasingly being used in OECD countries to improve access to primary and secondary care services. In 2008, the Quebec government (Canada) implemented centralized waiting lists (guichets d’accès aux clientèles orphelines – GACO) to help unattached patients to find a family physicians and prioritize patients with vulnerability criteria. In 2011, financial payment was increased for registration of vulnerable patients (200$/patient), and new payment was also introduced for registration of “non-vulnerable” patients (100$/patient).
Objective: This study aims to analyze the impact of changes in financial payments on family physicians’ registration of patients through GACOs.
Methods: Longitudinal quantitative analysis (2008-2013) based on administrative databases listing all patients registered through GACOs (N = 494 119). Analysis of variance models before and after change in financial payment had been realized by using mixed procedure in SAS 9.2 for the different patient’s characteristics.
Results: Patients registered through GACOs more than quadrupled after changes in financial payments. Most of this increase was attributed to registration of patients without vulnerability criteria. After the change in payment, 70% of patients registered through GACOs did not have vulnerability criteria, and most were referred to the centralized waiting list by the physicians who registered them.
Conclusion: Centralized waiting list linked to financial payments increased patient registration to family physicians. However, even if the amount doubled to prioritize vulnerable patients, physicians favoured registration of healthier patients to the detriment of those with greater needs. These results suggest that the introduction of financial payment without appropriate regulation may lead to opportunistic use of the incentive system and unintended policy consequences.