33e: Bonus is paid directly to physician also. Additional comments: Some provinces have relied on Pay-for-performance programs for various objectives; however, participation is usually on a voluntary basis and geared towards primary care physicians. To date, the application of pay-for-performance (P4P) programs in Canada is fairly limited. Programs vary by province, regional health authority and even within health care settings. Currently there are no pay-for-performance programs at the national level. Relevant examples include: Ontario physicians participating in past primary care reform models may receive bonuses with specified thresholds in five preventative care areas: influenza vaccine; pap smear; mammography; childhood immunizations; and colorectal cancer screening. In 2006, British Columbia introduced a family practice program which included an obstetrical care bonus payment and expansion of condition-based bonus payments related to monitoring patient care according to clinical guidelines for diabetes, congestive heart failure and hypertension. More recently, Manitoba paid a 20% premium on physicians' billings for those offering extended hours (6-8am, 5pm to midnight, 7am-midnight on weekends and recognized holidays). British Columbia introduced a Longitudinal Family Physician model in 2023 where it compensates physicians for the number of patients seen, the complexity of the condition, and for time spent on other necessary tasks like reviewing lab results, consulting with other medical professionals, updating patient lists and clinical administrative work.