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  • Writer's pictureDr. Aaron Rosenberg

Pros and cons of direct primary care.

Updated: Oct 26, 2023

Direct primary care (DPC) is a model of primary care in which patients pay a monthly or annual fee directly to their primary care physician or clinic, rather than paying for each visit or service through insurance. This model aims to simplify the primary care experience for patients and providers by cutting out the middleman (insurance) and reducing administrative burden. Patients with insurance can still join a DPC and use their insurance, though doing so does not always prove cost effective.

One of the main advantages of DPC is that it is often more affordable for patients. DPC patients pay a fixed fee per month or year and prices are transparent and predictable. DPC providers often offer discounts on certain services, such as lab work or medications, further reducing out-of-pocket costs for patients. Since DPC allows patients to communicate with their doctor directly via text or email, being a DPC member often provides the ability to avoid a costly visit to the emergency department. Since DPC can often offer remote e-consults with specialists, this can cut down on the need to see a specialist in person, also saving money for the patient.

Another way that DPC can cut down on the expense to consumers is by foregoing traditional insurance and using a health share. Direct primary care (DPC) can be paired with a health share program to provide a comprehensive healthcare solution. A health share program is a type of health insurance alternative in which members of a group share the cost of their medical expenses. Health shares are typically less expensive than traditional health insurance and often have a more limited scope of coverage, however that coverage gap is often filled by the DPC.

One way that DPC can be paired with a health share is by using the health share to cover the costs of specialty care, hospitalization, and other services not included in the DPC plan. For example, a patient might use their DPC plan for primary care services, such as regular check-ups and sick visits, and use their health share to cover the cost of any necessary specialty care or hospitalization. This can help to reduce out-of-pocket costs for the patient.

It is important to note that health share programs are not the same as traditional health insurance and may not cover all medical expenses. Patients should carefully review the terms of their health share plan and consider their healthcare needs before deciding whether a DPC-health share combination is right for them. It is also a good idea to speak with a healthcare professional or financial advisor to get more information about the potential risks and benefits of this type of healthcare arrangement.

Another advantage of DPC is that it allows primary care providers to spend more time with their patients, resulting in a more personalized and comprehensive approach to care. With traditional fee-for-service primary care, providers may feel pressure to see a high volume of patients in order to maximize their income. This can lead to rushed appointments and a lack of time to address all of a patient's concerns. In contrast, DPC providers are able to spend more time with each patient and offer a wider range of services, such as preventive care and health coaching.

Improved access to care is another benefit of DPC. Patients often have better access to their primary care provider, as providers are able to offer same-day or next-day appointments and extended hours. Many DPC practices allow patients direct access via text to their doctor. This can cut down on the all too frequently experienced headache of waiting for days to get an answer about an important health related question or concern. This can be especially helpful for patients with chronic conditions who need to be seen regularly or for those who need after-hours care. The doctor can often answer the question via text, completely avoiding the need for a visit.

In addition to the benefits for patients, DPC can also lead to increased satisfaction for primary care providers. The reduced administrative burden associated with DPC allows providers to spend less time on insurance-related tasks and more time on patient care. This can lead to a more enjoyable and fulfilling work experience for DPC doctors.

There is evidence to suggest that doctors who are satisfied with their work may provide higher quality care. A study published in the British Medical Journal found that doctors who reported high levels of job satisfaction had lower mortality rates among their patients compared to doctors with low job satisfaction. Other research has found that happy doctors are more likely to adhere to best practices and guidelines, communicate effectively with their patients, and have better patient outcomes.

While DPC has many benefits, there are also some potential drawbacks to consider. One disadvantage is that DPC does not cover specialty care, hospitalization, or certain procedures, so patients may still need to pay out of pocket or use insurance or a health share for these services. This can be a concern for patients with complex healthcare needs or those who require expensive procedures.

Another potential limitation of DPC is that it is not as widely available as traditional primary care. DPC may not be an option in all areas, so patients may have to travel to access a DPC provider. In addition, some insurance plans do not cover DPC, so patients may have to pay for both DPC and insurance. This can be a financial burden for some patients, especially if they have high insurance premiums.

Overall, direct primary care offers a more personalized and affordable primary care experience, but it may not be the best option for everyone. Patients should weigh the pros and cons and consider their specific healthcare needs before deciding whether DPC is right for them. If DPC is not an option, there are still ways to save money on primary care, such as shopping around for the best copays or looking for a primary care provider who offers discounted rates for uninsured patients.

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