Trying to understand the United States’ current managed care system can be a little bit like deciphering alphabet soup: EOB, HMO, PPO, HSA*. How did it get so complicated?
Athena du Pre explains in her text, Communicating About Health, that in the early 1980s, healthcare shifted to managed care organizations, which coordinate the cost and delivery of health services. While the goal of managed care was originally to make healthcare more standardized, efficient and affordable, many patients today find it to be anything but. Physicians typically are not happy with the structure either.
A 2014 Time magazine article described how some primary care physicians decided to start practices that didn’t take insurance. Instead, they attracted wealthy clients who would pay a five-figure annual fee to have immediate access doctors, schedule appointments on short notice and never have to flip through a wilted magazine in a waiting room again. These upscale practices became known as concierge medicine. However, other providers have now realized the benefits of this model can be reaped by people other than the rich.
Practices are springing up across the U.S. that don’t take insurance, but instead charge their patient-members a monthly fee of less than $100. These patients can visit a primary care physician as often as they want. Some practices also have discounted prescriptions and others even offer benefits like gym memberships. Members should still have private insurance in case of hospitalization, but if they choose a high deductible plan, the cost of the lower premium and the concierge membership likely won’t add up to more than what they were paying with their previous plan.
DuPré, A. (2017). Communicating about health: Current issues and perspectives (5th ed.). New York: Oxford University Press