by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
Obamacare’s third annual enrollment period for health insurance is officially underway. Americans who do not have access to employer-sponsored health insurance, are self-employed, or have been dumped into the individual marketplace by their employers have the opportunity to sign up or renew their government-knows-best health insurance plan. While low-income North Carolinians benefit from plans paid for by other taxpayers, middle-income residents are getting pummeled with some of the highest double-digit percentage premium increases in the U.S.
A recent article from The News & Observer tells the story of Janet Joyner, a Raleigh resident who is struggling to make ends meet when it comes to paying for health insurance.
Joyner said she’s healthy and used only about $500 in health care services last year, but paid Blue Cross nearly $6,700 in monthly premiums. Her current plan would cost nearly $9,500 in premiums for the full year, plus a $3,500 deductible that Joyner would have to pay before coverage kicked in.
"It’s like 2 1/2 car payments for me," she said. "I’d be paying $9,500 a year for my annual physical and lower prescriptions."
As health insurance is becoming more expensive, some basic health care is curiously becoming more affordable because an increasing number of primary care physicians are breaking away from the status quo. By cutting the cord with insurance companies, doctors can spend more time with their patients in exchange for upfront cash payments.
This simple and effective strategy is known as direct primary care (DPC). It brings back the incredible value of personalized medicine, and it’s a win for both doctors and patients.
Imagine not having to spend over 40 percent of practice revenue on personnel responsible for submitting claims to insurance companies. Opting out of insurance contracts allows solo direct care practices to break even on just four patients per day rather than 32 in today’s typical practice setting. DPC heightens providers’ professional satisfaction because they can escape the corporate environment of the ever-consolidating health care industry and instead hold fast to their autonomy. Calling their own shots under this business model allows for them to actually practice the art of medicine by scheduling longer appointment times with patients if necessary and even committing to house calls.
Because primary care is relatively inexpensive to administer, DPC is an affordable option for the masses. Just ask Dr. Brian Forrest, whose practice is located in Apex, North Carolina. He continues to emphasize this concept after seeing a Medicaid patient and a CEO sitting next to each other in his waiting room. For a monthly payment equivalent to a gym membership (not multiple car payments), patients are entitled to around-the-clock care. Despite limited data on direct care, existing literature concludes that patients enjoy an improvement in health outcomes while saving on overall health expenditures when compared to those navigating the traditional health insurance system. A study conducted by the University of North Carolina medical school and North Carolina State University MBA students found that patients seeking treatment at Dr. Forrest’s practice, Access Health Care, spent 85 percent less and enjoyed an average of 35 minutes per visit compared to 8 minutes in a non-direct care practice setting. Other studies have shown similar results.
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