By Lawrence Reaves

Debates about healthcare have been turning up in news stories for years. There is no debate that people need access to good medical care and that those who see doctors regularly and receive preventative care are healthier. The debating begins when people begin discussing what the best way to deliver that care is and how it should be paid for. There are as many ideas for solutions as there are doctors and keeping track of the options is sometimes hard to do. Most people in the United States currently receive care under a system called primary care. You are probably familiar with how this works. You go to your doctor, present an insurance card, receive care, and you doctor bills the insurance company. There are several flaws in this current system, but that is not the goal of this article. In response to this somewhat failing system of health care a few new care delivery concepts have been gaining popularity. Direct Primary Care and Concierge Medicine are two new ideas that are being adopted by doctor’s offices across the United States.

The philosophy of these two alternative solutions is similar. Both include a payment structure that holds the patients responsible for the cost of their care and both allow the doctors office to circumvent the extensive costs incurred by insurance coding staffing requirements. The decreased overhead costs at doctors’ offices who are trying these new business models have enabled them to deliver more personal care. Also, the lower the cost of doing business, lower the doctor needs to charge for a service. These basic principles are what make these two plans related, along with the fact that they both charge patients a fee up front for service.


Where the plans differ is what the fee charged covers. Under concierge medicine, the fee patients are paying only covers their ability to gain flexible access to their healthcare provider. The fee helps doctors cover the cost of running the office and allows them to keep their patient load down. This in turn provides patients the ability to schedule last minute appointments and take more time talking to their doctor about their problems. While some concierge medicine offices do not take insurance in order to cut costs further, others do. This is where concierge and direct primary care offices differ.

A direct primary care office’s principle is founded in the idea that cutting out the middle man, the health insurance companies, enables them to deliver more affordable care. The fee that patients pay to a direct primary care physician’s office covers the costs of basic care for the year. Eliminating the extra office employees that are needed to process insurance paperwork is how these offices are able to provide more personal attention to their patients. Fees paid by the patients cover their care. If you look at how much doctors spend on processing insurance it turns out that for every dollar paid to the office around forty cents goes to pay for insurance processing costs. That is nearly half of the money the office takes in.

About the Author: Join the

Private Healthcare debate

with AAPP, the

American Academy of Private Physicians



Permanent Link: