The Structure and Process of Workers' Compensation Systems and the Role of Doctors: A Comparison of Ontario and Quebec

Background This study sought to identify impacts of compensation system characteristics on doctors in Quebec and Ontario. Methods (i) Legal analysis; (ii) Qualitative methods applied to documentation and individual and group interviews with doctors (34) and other system participants (31); and (iii) Inter-jurisdictional transdisciplinary analysis involving cross-disciplinary comparative and integrative analysis of policy contexts, qualitative data, and the relationship between the two. Results In both jurisdictions the compensation board controlled decisions on work-relatedness and doctors perceived the bureaucratic process negatively. Gatekeeping roles differed between jurisdictions both in initial adjudication and in dispute processes. Quebec legislation gives greater weight to the opinion of the treating physician. These differences affected doctors' experiences. Conclusions Policy-makers should contextualize the sources of the "evidence" they rely on from intervention research because findings may reflect a system rather than an intervention effect. Researchers should consider policy contexts to both adequately design a study and interpret their results. (C) 2016 Wiley Periodicals, Inc.