Direct primary care has been promoted by certain groups of physicians as a means for patients to save money on their primary care services, as well as other ancillary-performed services such as laboratory testing, etc. Often, there are no insurance co-pays, deductibles or co-insurance fees thus avoiding the overhead and complexity of maintaining relationships with insurers. Under this model, patients may pay a combination of visit fees and/or fixed monthly fees which grant them access to a set of medical services, including same and next-day appointments, which may take the form of office visits and/or house calls. Typically a direct primary care arrangement is paired with either:
Direct primary care practices do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can take as much as $0.10 - $0.20 of each medical dollar spent. Consequently, because direct pay members are usually automatically billed a physicians practice's cash flow can also be improved. An emerging model of direct primary care involves the medical practice contracting with self-insured employers who offer the direct primary care option as a means of accessing care for free or drastically reduced office visit fees. This is also known as onsite health. The employer pays the membership fees on behalf of the employee to the DPC practice directly. This option usually provides the employee same or next business day access to care. This allows workers to address evolving health concerns rapidly in order that the condition can be treated more quickly and the number of sick days or days of decreased productivity from illness might be reduced. Many DPC practices provide phone or email access to providers so that employees or patients may not even need to leave their workplace to seek medical advice. Because direct primary care payments are typically paid over time, rather than in return for specific services, the economic incentives are such that the long-term health of the patient is the most lucrative situation for the doctor. As such, preventative care gains greater emphasis under DPC.
Criticisms
Opponents of direct primary care models assert that direct primary care is unethical, primarily benefitting providers and not patients. The USPatient Protection and Affordable Care Act requires that DPC practices offering such services must include in their plans a secondary qualifying health plan that covers other hospital services that the DPC provider may not offer if they choose to offer their DPC arrangement in the healthcare marketplace. Therefore, in cases where the DPC provider has chosen to participate in the healthcare marketplace, the patient would be required to carry and pay for an additional insurance coverage plan for catastrophic and hospital services in addition to the DPC arrangement for primary health care access if he/she purchases this plan from the healthcare marketplace. It is argued that DPC plans can be more expensive in the long term, since by design none of the payments made to the DPC provider practice are counted towards insurance deductibles because the provider neither accepts insurance nor participates in the submission and management of the insurance claims process, potentially resulting in a higher out-of-pocket catastrophic or hospital services cost to the patient because deductibles would not necessarily have been reached when these services are provided.
