Direct primary care, in which physicians are paid a subscription fee directly by their patients, is so self-evidently better than the present, insurance-driven system that one has to ask why it has not been popular before now. The answer lies in the changes that have occurred in health insurance in the last decade or so.
There was a time when most health insurance coverage came with only a small deductible, which is the amount of money a patient has to spend on his health care each year before his insurance started paying the bills. Some health insurance plans had no deductible at all. For patients with insurance that pays almost all of their medical expenses, direct primary care has little to offer, a subscription to a physician’s practice would be an additional expense the patient doesn’t need to access routine care. Concierge practices have for some time been serving insured patients by offering a higher standard of service in exchange for a subscription fee, but they have not gained a lot of market share to date. Most patients were satisfied with the care they were getting as long as they weren’t paying much out of pocket for it.
Health insurance with low deductibles has increasingly been too expensive for patients or their employers to afford. Most of the health care plans offered these days by employers, and those privately purchased under the Affordable Care Act, are high deductible plans requiring patients to pay thousands of dollars for their health care before their insurance company writes a single check. In fact, most patients go through every year without drawing any money at all from their health insurance. The insurance companies negotiate prices for their customers, and impose mountains of paperwork and restrictions on their behalf, but they actually pay the bills for relatively few of their customers. Increasingly, the patients are paying for themselves.
Patients covered by high deductible health insurance plans do not seek as much health care as those with better insurance, and the total amount of spending on health care in this country has not been rising as fast as it used to. Holding down health care spending sounds like a good thing when a politician or a newscaster says it, but that ignores the fact that some health care spending is truly useful. If health care spending was just being controlled by patients going without unnecessary care, then I would be all for it, but studies have shown that when patients choose not to get health care because they can’t afford it, they also go without necessary, sometimes lifesaving care. Patients should be able to get help when they feel they need it, without worrying about whether their problem is worth the expense.
This is the problem that direct primary care was invented to solve. Patients who subscribe to their physician’s practice can contact their physician when they feel the need without running up another bill. The visit can be in person, by phone, or any other way that serves to solve the problem. This relationship can save patients money by keeping them out of the emergency rooms and urgent care centers that are providing far too much of our primary care these days, and eating up patients’ deductible payments. A direct primary care subscription can easily pay for itself by keeping a patient out of an emergency room just one time.
The future of health insurance is that patients are going to be paying their own bills for all but the biggest illnesses and accidents. Direct primary care allows them to spend their money on someone they trust, who knows them well, and has their best interests at heart.