RIAFP Policy
Brief: 6/17/03
Alternative Primary Care Financing
The current, fragmented, HMO-based health care financing system is
fraught with problems. While the number of uninsured continues to
rise nationally, costs have not been held down as promised, and productivity
pressures, increasing rules and regulations and concern for short-term
profits compromise the physician-patient relationship.
Several Rhode Island Family Physicians have implemented a novel primary
care financing model, which offers comprehensive primary medical care
affordably.
In exchange for a low, fixed monthly fee paid directly to physicians
(in the range of $25 per month or less), plus a nominal per-visit
fee, patients receive unlimited medically necessary office visits,
including complete physical exams, routine immunizations and all necessary
follow-up and acute sick visits.
Standing alone, the model provides quality preventive and timely
acute medical care that promotes overall health and reduces the chance
of more severe health problems.
Beyond that, it is an excellent fit with high deductible, low-cost
catastrophic insurance that caps out of pocket expenses when more
serious illness strikes. And the model should be especially attractive
to small businesses as an affordable benefit to attract and retain
quality employees.
Financing of "gap" services falling between the primary
care fee catastrophic insurance deductibles (i.e., lab, x-ray, specialist,
drugs, emergency department and hospitalization) may come from various
combinations of personal savings, Medical Savings Accounts, defined
contribution plans, and a government safety net for those least able
to afford them.
If widely adopted, this model would help restore primary care as
the cornerstone of health care, offer affordable primary medical care
to many more individuals and smaller employers, restore the focus
on the doctor-patient relationship and vastly reduce administrative
costs and burdens.
We support a social, legal, regulatory and insurance environment
which: is without barriers to this financing model; ensures a level
playing field with existing health financing models; allows tax-exempt
contributions to Medical Savings Accounts; and provides market access
for low cost, high deductible indemnity health insurance products.
We
can be reached by phone at 401-453-4176, or at www.riafp.org.
This is one
in a series of reports designed to advance Family Practice and primary
care in Rhode Island's health care system, as well as to discuss public
health issues of importance to all Rhode Islanders.
We welcome
the opportunity to further discuss the issues presented here. We can
be reached by phone at 401-453-4176, or by email at info@riap.org.
2/5/03
