What You Need To Know About Direct Primary Health Care

By Mark Di Vincenzo. May 7th 2016

As the national debate rages over the best and most cost-effective way to provide health care to all Americans, a small but growing number of primary care physicians say they have found a business model that they swear is better in every way than the traditional health care model.

It is called direct primary health care and the doctors who use it say it saves consumers money, improves everyone’s long-term health and reduces administrative headaches.

The most radical thing about direct primary health care is that it bypasses the health insurance system entirely. Read on to find out what you need to know about direct primary health care.

So How Does It Work?

Consumers -- through their employers or their union -- pay a monthly fee to doctors and get all the primary care they need.

How Much Is That Monthly Fee?

It depends, but most patients pay somewhere between $50 and $150 and that pays for all of the routine care from a primary care doctor.

What About Care From A Specialist?

Consumers need to buy insurance to see anyone who is not a primary care doctor, including specialists.

Do They Need Insurance For Anything Else?

Yes, for emergency care. Urgent care centers and hospitals have not embraced this way of providing health care. (A lot of patients in this model use health savings accounts to pay for their health insurance so they enjoy tax deductions as do others who use health savings accounts.)

Where Are These Direct Primary Health Care Practices And How Many Patients Are Treated This Way?

About 100,000 patients in 24 states see direct primary health care doctors according to the Direct Primary Care Coalition, an advocate for this model.

When Did This Model Start?

About 10 years ago. The seed for direct primary health care came from something called the concierge model in which wealthy people bypassed health insurance companies and paid doctors who made house calls and generally were more accessible to patients. The concierge model still treats the rich.

Why Does Direct Primary Health Care Appeal To Patients?

Doctors in this model argue that because patients pay a fixed price, the doctors have no time constraints and don’t feel rushed. As a result, doctors spend more time with patients – as much as 10 minutes more per visit according to some studies -- and that makes patients feel better about the experience. What’s more, direct primary health care doctors typically work in groups, in some cases allowing them to see patients seven days a week and even at night.

Working On Weekends And At Night Doesn’t Sound Very Appealing To The Doctors In This Model. What’s In It For Them?

Well, they’re paid a monthly fee from patients whether or not they see the patients, so they’re often making money even when they’re not working.

Those who think this is a great system point out that direct primary health care doctors make money by keeping patients happy instead of making money by ordering tests and billing health insurance companies. If they can keep their patients happy, they will keep their patients who will continue to pay that monthly fee to their doctors who will continue to receive it whether or not their patients are sick. One study concluded that doctors in this model earn three times more revenue per patient than doctors in traditional practices. Think of it this way: The medical practice in this system is receiving a lot of the money that the insurance companies receive now.

Is There Any Other Advantage For Doctors To Join A Direct Primary Health Care Practice?

Doctors’ offices in this model spend less time filling out paperwork and filing claims. As a result, these practices often employ fewer business office staff members because there is no need to deal with insurance companies and track down patients to get them to pay their bills. They can operate more like old-fashioned country doctors.

What About Patients Who Get Referred To Specialists Who Aren’t Working In The Direct Primary Health Care Model? Doesn’t That Bring Up A Lot Of Issues?

It can, but doctors working in this model tend to refer patients to specialists who respect the direct primary health care model and agree to be more accessible and responsive to patients. After all, patients in this system have come to expect that and they have come to expect more of their doctors’ time.

So What’s The Future Of This Movement?

It’s growing, but it serves less than .03 percent of all Americans so it has a long way to go. Insurance companies certainly don’t like it and are hoping that doctors won’t want to change the way they have always done things. But if primary care doctors, who make less money than most other doctors, really can make much more money in this model, it may really take off.

The bottom line is that you should weigh all of the pros and cons before deciding to get direct primary health care. This will allow you to make the best decision for you and your family.


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