You're right - for specialists and some GPs but not all. About half of the GPs are paid by their roster size, so-called "capitated payment". The idea being a doctors pay should be based on how healthy they keeps their patients rather than how many services they administer.

I only point that out for our American friends who might counter with "well isn't that a system ripe for abuse"

Really, do you have a source for that? I assumed everything, basically everything public insurance driven, which are most things, are negotiated by the government.

Just like how family/walk-in doctors get paid in 15 minutes increments so they try to rush as many patient through the day since they get paid for 15 whether it was a 2min appt or not. Which is why you see walk-ins packed full of people with well over an hour times, because not every meeting is fast.

On the other hand, I assumed the specialist got paid for their individual services they provide (and the orignal doctor got rewarded for the referral), since that's what they get referred to do, a specialized service which can be rated. It's also why radiologists ($800k/yt) are the highest paid doctor-type, complicated stuff requires good pay and they negotiate these on a case-by-case basis.

Edit: I found a paper talking about capitation in Canada and it mentions that Ontario is the only pr]ovince doing it and not all GDPs opted-into it. This sounds interesting - if a bit trusting of the people reviewing "performance". But I support testing out new payment systems, the current one could use some optimisation no doubt.

Same in Switzerland. Prices for services are fixed, and mandatory basic insurance won't pay more. Doctors and private hospitals are free to do their own thing, as long as their clients (or their additional insurance) are willing to pay the difference. I think only hospitals are in public hand, but they still have to go via the insurances for payment.

France is the same, or it was when I was participating in it.