There are distinct advantages for the patient who pays the primary care physician (PCP) directly: higher quality, lower cost and greater satisfaction.
The fundamental problem in health care delivery today is a payment system that is highly dysfunctional leading to higher costs, lesser quality and reduced satisfaction. The core problem? The patient is no one’s customer. With employer-based insurance, the physician’s customer is the insurance company that sets the rates, defines the rules and accepts or denies the bill. And the insurer’s customer is the employer. This is much different in concept and function than the professional-client relationship with your lawyer or tax accountant. Those relationships are direct; you establish your requirements, negotiate the fee or choose a different provider. In medical care, the patient has no standing in the financial arrangement whether employer-based insurance or Medicare or Medicaid.
Add to this the non-sustainable business model PCPs find themselves in today. Insurers have kept reimbursements flat for a decade or more. Meanwhile office costs have risen. With more expenses and static revenue, the PCP tries to “make it up in volume” by seeing more patients for shorter visits. Twelve to 15 minutes may be fine for a quick blood pressure medication check or a sore throat but it is not enough for good preventive care. Nor is it adequate for the patient who has a complex chronic illness (e.g., diabetes, heart failure or cancer), which consumes 70-85% of insurance claims paid. This patient will need a multi-disciplinary team of providers to render all the care needed. But the team needs a quarterback and if care is not well coordinated by the PCP, the number of specialist visits will skyrocket, as will tests, procedures and expensive prescriptions
Why patients should pay doctors directly