A new study by the Harvard Medical School entitled Health Insurance and Mortality in U.S. Adults was recently published in the American Journal of Public Health. It found that 45000 deaths each year are linked to those without health insurance. The study found that uninsured, working age Americans have a 40% higher risk of death than their privately insured counterparts. This is up about two and a half times from the estimate in 2002 by the Institute of Medicine. Andrew Wilper MD the lead author of the study stated that “limited access to primary or preventative care likely explains a lot of this.”
This study keeps in front of us the reason for the heated discussion of the healthcare issue, which has been hotly debated since the time of William Jennings Bryan. Both sides of the current debate agree on our dilemma. There is wide agreement that we need to reform the incentives, make the consumer accountable for health care spending, make price information transparent, and reward healthcare, not services. However, there is wide disagreement over the size of the problem and the role of government in its solution. Common sense solutions should be the basis of our discussion and utilize the strengths of our current system. Many approaches should be considered.
There is currently a new approach to primary care that builds on our strengths as a nation and unleashes the entrepreneurial spirit and creativity based on the American genius. This primary care model helps improve the original concept of a family doctor, which better enables the practice to become a “medical home” The current system of reimbursing the physician by procedure often limits the time that is spent with the patient, and often creates a merry-go-round for the physician as he balances the desire to spend more time with the patient while confronting economic realities.
This new approach is becoming more popular as a way to have a win-win between the patient and the provider. The Direct Primary Coalition explains the plan. The patient pays a low monthly fee – sometimes as low as $49 – directly to the Primary Care facility for all of their everyday health needs. Like a health club membership this gives patients access to unrestricted access to visits. The patient can use the services as much or as little as they want. Secondary and Tertiary health care services are often covered by high deductible health insurance policy and a Healthcare Savings Account. Members go to their primary care providers for everything from regular check-ups, women’s health exams, sprained ankles, broken arms, and flu shots, to arthritis or diabetes management.
It has been estimated by the Direct Primary Care Coalition that the direct and indirect insurance costs in a typical primary care practice consume more than 40 cents of every healthcare dollar. Eliminating insurance from primary care through a direct-membership-based practice, allows the saved insurance dollars to be used by the physician to spend more time with the patient, and provide more extensive office hours. Further, more on-site services and diagnostics, more emphasis on health education that promotes wellness, and more technology that creates more efficiency can also be provided. This approach allows physicians to concentrate on patient needs rather than the requirements of health insurance. Although this system can work for employer sponsored health insurance it is maximized when used in conjunction with a high deductible individual insurance policy and an HSA.
The direct primary approach provides different levels of service plans. The consumer can choose the level of care they desire. This method is different than the concierge style which is a high-end plan that provides an exclusive arrangement. The direct primary care style provides incentives to work better with their physician to change their lifestyle and achieve the benefits of early detection of illness and avoid some of the diseases that are a result of lifestyle choices. This slant to primary care is similar to an HMO except that the physician and patient are more in control. The insurance company takes a back seat.
As we debate the role of government in health care we should be aware of the benefits of competition. The direct primary care model can provide a very effective alternative. The high deductible health insurance policy with an HSA has become very popular since their inception a few years ago. It should definitely remain as an alternative in any health care bill that is adopted. Hopefully the changes being considered will not be a cookie cutter approach and will include incentives to innovate further in the development of private sector alternatives.