In the forty years since I started medical school, I have worked in socialized medicine, student health, a cash-only practice and a traditional fee for service small group practice. The bulk of my experience has been in a government-sponsored rural health clinic, working for an underserved, underinsured rural population.
Today, I will pull together the threads from my previous posts in the series “How Should Doctors Get Paid?” I will make a couple of concrete suggestions, borrowing from all the places I have worked and from the latest trends among the doctors who are revolting against the insurance companies by starting Concierge Medicine and Direct Primary Care practices.
Because I am a primary care physician, I will mostly speak of how I think primary care physicians should be paid.
I will expand on these concepts below, but here are the main points:
1) Have the insurance company provide a flat rate in the $500/year range to patients’ freely chosen Primary Care Provider, similar to membership fees in Direct Care Medical Practices.
2) Provide a prepaid card for basic healthcare, free from billing expenses and administration.
3) Unused balances can be rolled over to the following years, letting patients “save” money to cover copays for future elective procedures.
4) Keep prior authorizations for big-ticket items, both testing and procedures, if necessary for the health of the system.
5) Keep specialty care fee-for-service.
6) Have a national debate about where health care ends and life enhancement begins and who should pay for what.
Health insurance needs to be simple to understand and administer. It needs to promote wellness, and it needs to remove barriers from seeking advice or care early in the course of disease. It needs to empower patients to use health care services wisely by aligning patients’ and providers’ incentives.
Health insurance should not be deceptive. It should not promise to pay for screenings (colonoscopies and mammograms) and stop paying if the screening reveals a problem (colon polyps or breast cancer). It should offer patients the right to set their own priorities for their health while demanding concern for our fellow citizens’ right to also receive care.