Direct primary health care: Trending?


Growing up after the war, I remember my family belonged to a health care organization called Group Health. It was a cooperative with members, and members elected the board of directors. For annual physicals we went to the Group Health offices in Washington, D.C., but if we were sick, oftentimes the doctor would come to our house.

Later, in Connecticut, I remember having strep throat, the mumps, and the measles and in each case the doctor came to our house to treat me and at the end of the visit, my mother would write him a check. That’s a pretty pure example of direct primary-care medicine.

House visits by doctors in the 1930s were standard practice, but for all intents and purposes it had disappeared from medical practice by the 1960s. So, is it making a comeback?

Here’s one man’s opinion of the current state of medical care in America in 2023:

1. It is very expensive.

2. Progress made with Medicaid and the Affordable Care Act notwithstanding, many Americans still can’t afford the insurance to get routine care, to say nothing of catastrophic care for things like heart attacks, cancer, strokes or kidney disease.

3. It is also true that if you are privileged and wealthy you can get some of the best health care in the world in America. If you’re poor in America, our nation ranks embarrassingly far behind other first-world nations in health care.

4. Health care has taken on a disappointingly industrial feel, as primary-care physicians and insurance companies value quantity rather than quality personalized care.

5. Close to a quarter of all primary-care practices spend almost 25% of their income on the staffing and maintenance necessary for processing insurance claims.

6. Insurance companies build in their costs as middleman between doctor and patient driving health care costs up.

Public television has been running a series on health care and one segment was devoted to a trend that seems to be catching on, direct primary-care medicine. I welcome comments from those in the medical field if they think I have this wrong or if they have an opinion related to this.

Imagine a primary-care doctor going into private practice but estranged from health care insurance companies. He or she decides to limit clientele to 400 patients. To be included in that practice you pay the doctor $500 per year and $100 dollars per month ($1,700 a year). Need to see the doctor for a checkup, no out-of-pocket cost, no co-pays. Need to have a blood panel done, $4. Sick and need to see the doctor, no further costs except for medicines.

The additional benefit to all this is that the doctor remembers you, isn’t rushed and crushed by schedule, and can actually spend time with you talking about important preventive medicine for you at your particular stage in life.

Imagine no more. As a model of practice it’s trending. Doctors don’t like the industrial model of practicing medicine any more than you do.

As an example of this direct primary care in practice, the PBS segment interviewed a young man, probably in his 30s, working, but unable to afford the hundreds of dollars a month for basic health insurance. Instead, he opted into a direct primary-care practice for hundreds less a month and bought an inexpensive insurance plan that only covered catastrophic health care events. He gushed over the personalized care he was receiving and was now happily into the routine of regular preventive care.

Removing insurance companies from the doctor patient relationship is not a novel idea. As I said earlier, I was brought up in an era where more personalized medicine was practiced. According to Hint Health, Direct Primary Care (DPC) is being practiced in 49 states with a 35% year-over-year growth rate in DCP clinic locations, with the hopeful promise of making quality primary-care accessible for the uninsured and under-insured. Why is there this kind of growth rate in DPC?

The 2021 Kaiser Family Foundation Employer Health Benefits Survey found that “Family premiums for employer-sponsored health insurance reached $22,000 in 2021, a 47% increase over 10 years. That’s why many small employers are taking a hard look at a new employee benefits strategy- direct primary care.”

HSA for America, an organization that helps people and businesses find healthcare solutions puts it this way: “Direct primary care has proven to be a massive success

among both employers and patients. A recent study found that direct primary-care membership has exploded, growing 241% from 2017 to 2021 – representing a compound annual growth rate of 36%.

As I said earlier, I’d be interested in other opinions on DPC, but this trend in primary-care seems like a trend worth learning more about. The secret to good health is preventive primary care, and if it can be done in a more personalized way, and at a more affordable price, it’s worth a closer look.

Bill Sims is a Hillsboro resident, retired president of the Denver Council on Foreign Relations, an author and runs a small farm in Berrysville with his wife. He is a former educator, executive and foundation president.

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