33e: Bonus is paid directly to physician also. Additional comments: Pay-for-performance programs are being introduced in limited volume at the provincial level; however, participation is on voluntary basis and geared towards primary care physicians. To date, the application of pay-for-performance (P4P) programs in Canada is very limited. Certain jurisdictions have introduced payment incentives for provision of specific services (Nova Scotia, Ontario, Manitoba, Alberta, B.C.), however few payments require achievement of quality of care targets (e.g., immunization rates). 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 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 (B.C.) introduced a family practice incentive program which included an obstetrical care bonus payment and expansion of condition based bonus payments related to monitoring patientsÕ care according to clinical guidelines for diabetes, congestive health failure and hypertension. Although not strictly P4P, in Canada many provinces have set up incentive programs to encourage family physicians - and in some instances specialists - to adopt and use approved Electronic Medical Record (EMR) systems. Generally, these programs include phased payments, up to a maximum amount, for the implementation of an EMR solution and the achievement of milestones or key features. Saskatchewan also makes a $1 payment to doctors per patient visit billed though the EMR.