Over the years, the healthcare industry has come up with lots of ideas to create value, lower costs, and improve people’s health. Most have failed, some have helped a bit, and a few are just repeats of ideas we tried in the ‘80s.
But, at some point, shouldn’t we stop trying to build on a broken foundation and just start from the ground up?
One of the main reasons our health care is so bad in the first place is because the players aren’t incentivized correctly. It’s a maze of third-parties, contracts, and networks that are all competing for market share at the expense of individuals and businesses.
Your doctor can only afford to spend 10–15 minutes with you
For most people, it makes sense that you work for whoever pays you. But in the U.S., we have a three-party system for health care: The patients (you), the insurance companies, and the providers (doctors/hospitals). Contrary to popular belief, you don’t pay your doctor for their services. Yes, you might pay co-pays or hospital bills, but that’s not where the majority of their income comes from. The insurance company (i.e. United, Blue Cross, Aetna, Cigna, Humana, Medicare) pays them for their services, and you (or your employer) pay the insurance company for coverage.
This means that doctors and hospitals actually work for the insurance companies, not the patients. That’s who pays their bills. You’ve felt this before even if you didn’t realize it. You wait days or weeks to get an appointment scheduled with your doctor. Then you sit in the waiting room. Then you get worked up by a nurse. And finally, the doctor comes in for 15 minutes. The last time I went to see a primary care doctor, he literally (and figuratively) stood in the open doorway with one foot out the door while I was trying to ask him a question.
Even though my doctor wants to spend more time with me, he’s also trapped in the insurance model and, unfortunately, doesn’t work for me. In order for his practice to survive, he needs to see 20–30 patients every day and complete all their insurance paperwork.
8 hour work day = 480 minutes
480 minutes / 20 patients = 24 minutes per patient
Now subtract time for paperwork, bathroom breaks, and miscellaneous tasks. You’re left with 10–15 minutes for each patient visit.
DPC doctors actually work for you
Fortunately, there are some trends that don’t subscribe to this three-party system and simplify the process of going to the doctor. Direct primary care completely skips insurance. Patients pay cash to see a doctor as much as they want through a low-cost membership.
These doctors were all trained the same way as every other primary care doctor. They went to the same medical schools and trained in the same hospitals. But at some point, they realized that there is no law in this country that forces them to operate through insurance companies. As licensed physicians, they can provide their services to anyone and insurance companies don’t have to be the gatekeepers.
It used to work this way. For hundreds of years, doctors functioned like any other profession. They worked for their customers and were paid directly by them. And they actually spent time caring for their patients and understanding their needs over many years. DPC doctors are bringing this style of practice back, and it’s helping people across the country. These doctors are among the few in healthcare that are actually adding value rather than more bureaucracy, and we need to encourage them.