If GEICO required authorization every time you took your car into a garage for an oil change, you’d probably find it wasteful, expensive, and irritating. Yet, when a patient visits a doctor—even for the smallest of needs—it’s common to involve an insurance company. This is costly for patients, time consuming for doctors, and burdensome for everyone. If we can pay a mechanic directly for routine car care, why not take the same approach more often in health care?
As a medical doctor and health policy instructor, we can appreciate the merits of this idea, which is known as direct care. It’s also currently being debated in Montana’s Senate, under Senate Bill 101.
In health care, we’re all accustomed to insurance companies stepping between doctor and patient and telling both what to do. Direct care, by contrast, provides greater flexibility to deliver affordable health care, as well as stronger doctor-patient relationships.
One type of direct care—direct primary care —has been growing across the country. It allows people to pay a low, fixed monthly fee directly to a physician or medical practice in exchange for an agreed-upon set of primary care services. While it’s still wise to purchase insurance for emergencies or serious medical issues, a good DPC agreement can cover most of the issues for which you’d see your primary care doctor.
In the case of SB 101, the bill would prohibit government programs and insurance companies from penalizing doctors solely because they offer direct care as an option, and clarify that it’s not an insurance product. The bill would also broaden rules about who can offer direct care, meaning other types of clinicians, including dentists and chiropractors, could do so.
Here’s one reason we should be having this debate: For years, America has struggled with too few primary care providers, especially in rural areas. We all agree that physician time is invaluable, yet we’ve somehow arrived at a status quo in which 20 to 30 percent of a physician’s day is consumed by administrative work related to insurance and regulatory compliance. These administrative burdens and lost time with patients contribute to physician burnout, causing some to leave medicine altogether.
The direct care model has reversed this trend for some clinicians. Many report experiencing greater job satisfaction and less burnout, as the model empowers them to do what they’re trained to do best—concentrate on patients’ needs—without the unnecessary and onerous paperwork burdens. In fact, it offers physicians a work-life balance that is seldom found anywhere else in the medical world.
Patients benefit as well. They receive the full attention of their doctors, have access to doctors outside of business hours, and—unlike with most insurance transactions—can see exactly what they’re paying for. Plus, the combination of direct care membership and high-deductible health insurance coverage is more convenient than conventional health insurance, because it’s less likely to be tied to the patient’s employer or employment status. Patients can keep the arrangement if they change or lose their job.
This model is exactly what some types of clinical practices need in order to make care better and more efficient. Other types of practices, where the gains would perhaps be smaller or the changes less feasible, may choose to stick with way they currently do things.
We shouldn’t be looking for a one-size-fits-all solution. The important thing is to allow different health care approaches to bloom, and let the future to be determined less by the opinions of state or federal officials and more by the experiences of patients and their physicians working together.