Primary care is a pretty low overall component of healthcare spend, but a direct primary care model could have an indirect effect that is much more substantial -- reducing hospital costs
Hospital care is the biggest component of US healthcare spend at 30% and costs per hospital bed are dramatically higher in the US than other OECD countries
Much of this is due to local hospital monopolies, which are extending to include primary care. When a big hospital buys a primary care clinic the cost of care at the primary care clinic immediately increases, sometimes dramatically, bc the primary care clinic now bills using the hospital systems insurance contracts. Huge hospital systems can basically dictate price to payers in many geographies. These payers then squeeze independent docs even harder to try and make up for getting pushed around by large hospitals. Hospital employment of primary care docs is at an all time high, despite many physicians (even hospital employed ones) thinking that this trend hurts patients and costs more
Plus, the primary care clinics now direct all patients to the big expensive hospitals, and the hospitals can even dictate patient flow within the system ("steerage") beyond just passively capturing the primary care practices patient volume
What’s your take on the increased cost component due to US hospitals mostly having private rooms? If the US were to build all new hospitals with multi patient rooms, how long before the cost curve bends down to rest-of-OECD levels?
Direct primary care used to be the only model; this in living memory. Insurance started out as disaster only care, and then bureaucratic creep took it from there. Now we have a system where nobody can practically tell you the cost of a service until after you’ve committed to pay for it. Beating a system with that level of information inefficiency by 95% isn’t even surprising.
The pendulum swings both ways? we started off with direct primary care, then moved to fully insured care, things are moving back towards direct primary care, i believe the model presented in the article or something along those lines will be what the US healthcare system will move to over the next 10-20years.
I run a competitor to Atlas MD, we've been testing our product by creating a clinic in South Carolina. Feel free to ask me anything (within reason) and I would be happy to do my best to answer your questions.
Not sure, but one barrier not mentioned in the post is the health insurance industry and its enormous clout. Right now, direct kale care is not seen as a threat, but if it ever is seen as a threat, you can bet it will be targeted. Look at how the industry was able to protect itself during the passage of the ACA. And how many people in Congress have Direct Care lobbyists gotten elected?
The biggest hurdle is regulatory. There are a number of legal barriers to direct primary care, and the laws vary state to state. Most private practitioners don’t have the choice to start a direct primary care practice because their state laws classify the model as insurance. This makes “scalable” DPC hard to achieve unless these laws change.
The other barrier is the supply of primary care doctors in the first place. There simply aren’t enough primary care doctors to make DPC an efficient scaled model. Family medicine is sadly the lowest paid field in medicine; while DPC can lead to higher salaries for current practitioners, it won’t solve the supply problem in the short term.
"Direct primary care only works as a complement to insurance that pays for more catastrophic care like emergency room visits and specialists."
This is like saying: "I've found a solution to high auto insurance costs! You can save lots of money and pay directly for small fender benders! Oh, by the way, if your car is totaled, you'll need to find someone else that covers those very costly catastrophes."
One could also argue the current model is more like "I found a solution to routine auto maintenance costs! Our super premium insurance includes oil changes, tire replacement, and other routine service."
Part of the problem with health insurance is that it's not just "insurance" in the true sense of the word - it's involved in minor and routine care as well. I don't have to involve my auto insurance company when I run over a nail and get a flat tire - why do I need to involve my health insurance when my kid has an ear infection?
I understand why we got here - preventative care reduces costs, and people would avoid it if not included in the main package. But there isn't a doubt in my mind it hasn't distorted the market.
Get a price quote for a windshield replacement paid directly and through an insurance claim. It's a LOT more expensive, overall, when insurance is involved. Health insurance is not fundamentally different in that way.
Depending on the test or procedure a 95% reduction in price is doable. Our clinic does every test and procedure at cost to remove the financial incentive to order. The wholesale price for most things is very low. For example, we charge patients $2.50 for a rapid strep test which would be normally be reimbursed at ~$16.50 with medicare/medicaid.
[+] [-] aaavl2821|7 years ago|reply
Hospital care is the biggest component of US healthcare spend at 30% and costs per hospital bed are dramatically higher in the US than other OECD countries
Much of this is due to local hospital monopolies, which are extending to include primary care. When a big hospital buys a primary care clinic the cost of care at the primary care clinic immediately increases, sometimes dramatically, bc the primary care clinic now bills using the hospital systems insurance contracts. Huge hospital systems can basically dictate price to payers in many geographies. These payers then squeeze independent docs even harder to try and make up for getting pushed around by large hospitals. Hospital employment of primary care docs is at an all time high, despite many physicians (even hospital employed ones) thinking that this trend hurts patients and costs more
Plus, the primary care clinics now direct all patients to the big expensive hospitals, and the hospitals can even dictate patient flow within the system ("steerage") beyond just passively capturing the primary care practices patient volume
[+] [-] ShorsHammer|7 years ago|reply
Both US government and private health costs are well out of line with the rest of the world. Certainly not getting value for money.
https://data.oecd.org/healthres/health-spending.htm
[+] [-] coredog64|7 years ago|reply
[+] [-] User23|7 years ago|reply
[+] [-] bshep|7 years ago|reply
[+] [-] pg_bot|7 years ago|reply
[+] [-] achanda358|7 years ago|reply
[+] [-] jawns|7 years ago|reply
Not sure, but one barrier not mentioned in the post is the health insurance industry and its enormous clout. Right now, direct kale care is not seen as a threat, but if it ever is seen as a threat, you can bet it will be targeted. Look at how the industry was able to protect itself during the passage of the ACA. And how many people in Congress have Direct Care lobbyists gotten elected?
[+] [-] amb23|7 years ago|reply
The other barrier is the supply of primary care doctors in the first place. There simply aren’t enough primary care doctors to make DPC an efficient scaled model. Family medicine is sadly the lowest paid field in medicine; while DPC can lead to higher salaries for current practitioners, it won’t solve the supply problem in the short term.
[+] [-] sparkpeasy|7 years ago|reply
This is like saying: "I've found a solution to high auto insurance costs! You can save lots of money and pay directly for small fender benders! Oh, by the way, if your car is totaled, you'll need to find someone else that covers those very costly catastrophes."
[+] [-] lostapathy|7 years ago|reply
Part of the problem with health insurance is that it's not just "insurance" in the true sense of the word - it's involved in minor and routine care as well. I don't have to involve my auto insurance company when I run over a nail and get a flat tire - why do I need to involve my health insurance when my kid has an ear infection?
I understand why we got here - preventative care reduces costs, and people would avoid it if not included in the main package. But there isn't a doubt in my mind it hasn't distorted the market.
Get a price quote for a windshield replacement paid directly and through an insurance claim. It's a LOT more expensive, overall, when insurance is involved. Health insurance is not fundamentally different in that way.
[+] [-] asn0|7 years ago|reply
Are most doctors set up to provide cash quotes and accept cash payment, or would I need to find specific doctors if I want to pay cash?
[+] [-] Animats|7 years ago|reply
[+] [-] pg_bot|7 years ago|reply
[+] [-] CrendKing|7 years ago|reply