Once upon a time…if a person became sick, he or she might call up the doctor who would show up at the doorstep. The doctor would diagnose and treat the issue, check back in a day or two for follow-up, and be available on call if further issues arise. As one can imagine, the doctor would charge a fee for his services, although legend has it that the doctor’s care would be available to everyone in town… not just to the wealthy.
Today, there is a prevailing mindset that in order to see a doctor, a patient has to have insurance. No insurance, no doctor. Is that true? Why does it have to be that way?
Many would be surprised to learn that it doesn’t.
Have you heard of “third party billing”? Many have, but don’t really know what it means. In health care, there are two main “parties”: (1) the patient, and (2) the health care provider. Third parties are entities who pay for and are therefore involved with care, apart from the provider and the patient. These are the health care plans, which of course include insurance, as well as government-subsidized plans such as Medicare or Medicaid. The understood process is that patients pay into the health plans, whether through premiums or taxes, then the health plans pay the medical providers. Unfortunately, it is not that simple, and things are only growing increasingly complex when these third parties are involved.
Enter: Direct Primary Care
Because the complexity of health care has become essentially universal (in other words, it is complicated everywhere), it seems impossible to simplify it. But in fact, it is quite possible. Just remove the third party. When the financial relationship between the patient and the provider is direct, so is the health care relationship – which is the way it was always meant to be. Doctors who don’t have to spend exorbitant resources communicating with health plans –surprise, surprise– have more time and resources to spend just caring for patients. We are doctors, not business-folk. Caring for patients is all we have ever wanted to do. By charging a monthly or annual membership fee that generally costs less than a TV bill, Direct Primary Care practices can provide around-the-clock availability, relaxed and thorough office visits, personalized attention, and in many ways, actual cost savings to their patients.
You may ask: Don’t doctors with cash-paying practices only cater to people with money to spare? I can’t afford that.
Answer: Contrary to how it may seem, Direct Primary Care is not the same as Concierge Medicine. Depending on a few factors such as age and medical needs, fees typically range between $50-$150 per month nationwide. This pays for a much higher quality of primary care than what third parties might cover, resulting in fewer ER visits, fewer hospitalizations, fewer high-copay speciality consults, fewer medications, and overall cost savings to patients.
You may ask: Is it worth it? I’m healthy enough, I rarely need the doctor and I already have insurance, so why bother?
Answer: If you become or perhaps an elderly family member becomes unexpectedly ill, do you want to sit for hours in the E.R. waiting room, or call your doctor’s office only to be on hold for half-an-hour then be told that there is no availability for weeks? OR would you prefer to pick up the phone –perhaps even initiate a video chat through Skype® or FaceTime®– and be greeted by the voice (or face) of a medical expert you have come to know and trust?
Think it over.