Direct primary care
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In the United States, direct primary care (DPC) is a type of primary care billing and payment arrangement made between patients and medical providers, without involving insurance providers. It is an umbrella term, incorporating various delivery systems that involve direct financial relationships between patients and health care providers.[1] The American Academy of Family Physicians endorsed DPC.[2]
Direct primary care is promoted to save money on primary care services, as well as other ancillary services such as laboratory testing. Avoiding insurers eliminates the overhead and complexity of those relationships. The objective is to allow competition to drive access to higher quality care at lower prices.[3]
Fees are a combination of per-visit and/or monthly payments that cover a set of medical services, including same and next-day appointments, in office and/or at home.[4] Many DPC practices provide phone or email access.
Typically a DPC arrangement is paired with either:
- a high-deductible health plan,[1] as DPC alone does not cover catastrophic care such as most surgeries; or
- a health reimbursement account as the associated tax-benefits can generally be applied to DPC and other medical expenses;
One of the lesser known provisions of the 2010 Patient Protection and Affordable Care Act (ACA) is Section 1301 (and amendment Section 10104). This allows DPC to compete with traditional health insurance options in a health insurance exchange when combined with a low-cost, high-deductible plan.[citation needed]
Onsite health is an emerging model involves the medical practice contracting with self-insured/funded) employers who offer DPC as a means of accessing care for free or reduced office visit fees. The employer pays the membership fees on behalf of the employee.
Another emerging model is partnering with HealthShare plans. Fees are sometimes reduced when participating in both a DPC practice and HealthShare plan. Coverage is more complete and affordable though still lacking certain services depending on both the DPC practice and Healthshare plan.
Advantages
DPC practices do not typically accept insurance payments, thus avoiding the associated overhead and complexity, which can take as much as 10–20 % of each dollar spent.[5] Patients are typically automatically billed, improving provider cash flow.
Rapid access to care can reduce the number of sick days or days of decreased productivity, benefitting the worker and the employer.[1]
DPC may encourage more doctors to provide primary care services or to continue practicing as they age, given the increased income, less-constrained time with each patient, and reduced administrative burden from insurance companies.[2]