Much has been written about how our current insurance model encourages doctors to perform procedures and tests rather than for time spent with patients. The role of the insurance companies, intervening between doctors and their patients, displeases both doctors and patients. Now some medical practices are leaving insurers out of the equation, and instead implementing direct-pay models where they charge patients a moderate membership fee each month. Doctors are free to spend as much time with patients and prescribe the types of medical treatments that the doctors believe best, in their professional medical judgment.
This approach has been encouraged, on a trial basis, under the federal health care reform law, but not everyone agrees it is the best approach.
The direct-pay approach has been implemented by at least fifteen different medical practices in the state of Washington, promoted by a 2007 state law which encourages “innovative arrangements between patients and providers,” such as direct-pay primary care.
According to a 2010 report to the Washington legislature from the state’s insurance commissioner, some of these practices are “concierge” practices, which are aimed at well-to-do patients, charging as much as $850 a month for personalized, high-touch services, but the largest growth is in practices that charge fees in the $85 to $135 range.
Primary-care physicians in many other states are offering similar services. For example, at Access Healthcare in Apex, N.C., members pay $39 a month plus $20 per visit for unlimited primary-care services, according Brian Forrest, the founder of this practice. He indicates that Access Healthcare has operated as a subscription-based practice for 10 years, and is now expanding via franchisees, the first of which are expected to open this summer.
This idea raises a number of questions, according to policy experts, including how direct-pay primary-care practices could charge monthly fees for preventive care services that under the new law are supposed to be provided free.
Some experts have more fundamental reservations. For example, Robert Berenson, a fellow at the Urban Institute, agrees that the current payment model for primary care doesn’t work very well, but, he says, “it doesn’t make any sense” to provide primary care outside the health insurance system. “This is not going to work for a lot of patients who can’t afford the out-of-pocket subscriptions.”
Read more about examples of this new direct-pay model for primary care in an article by Kaiser Health News and the Washington Post » Doctors try new models to push health insurers aside.
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