Prognosis: insurance vs. direct primary care

The average patient’s health insurance deductible has increased by 49% since 2011 and 51% of patients with a high-deductible health plans are required to pay upwards of $1,000 before their insurance kicks in. Direct primary care (DPC) is a method of healthcare that was popular in the 50’s and 60’s but lost traction when health insurance expanded from covering mostly catastrophic events to payment for nearly every health-related element.

With the expansion of health insurance, its costs began to soar and many doctors recognized a decrease in their ability to provide quality healthcare, eventually turning back to DPCs. Under this model, physicians do not accept insurance for routine visits and prescriptions, instead relying on patients to pay a monthly membership fee — about $100 a month — for unlimited access to healthcare, lower cost laboratory tests, and less expensive prescription medication.

This model benefits physicians who do not spend their income on overhead. It is estimated that for every doctor there is an average of 16 healthcare workers. Doctors also see many fewer patients overall;  500 to 1,000 versus approximately 2,367 annually. DPC medical practices also avoid costly insurance hassles: 60% of a medical practice’s revenue is typically spent on ensuring they are reimbursed by insurance companies and 30% of a medical office’s time may be spent on collecting insurance payments.

Patients stand to gain more from DPCs as they are more easily able to obtain same-day or next-day appointments (Merritt Hawkins reports an average wait time of 29 days), avoid copays and urgent care calls, which average $71 to $155, and get more quality time with their doctors who are focused on caring for the patient rather than fulfilling insurance company requirements.

DPC patients typically purchase additional coverage to account for more serious illnesses or purchase a healthcare sharing plan where the cost is spread out across patients who have medical expenses in the plan. Although DPC doctors are often paid less, many who have left insurance-dependent practices are happier as they are fulfilling their mission to truly care for their patients.


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