Letter: This healthcare model hurts the community
In response to Sen. McClaury's letter in the Bennington Banner on 3/27/18 on new options for funding primary healthcare, I have some concerns to share with folks who are considering new models of healthcare finance delivery systems. After discussing this matter with local members of the healthcare community as well as people like me who are trying to make sense of this issue.
The term "concierge medicine" comes to mind when we talk about putting doctors on retainers to be sure they will be available when we need them. This model is for the wealthy patients. An annual retainer locally is $1,650. The patient still needs to have insurance to cover the things that the primary physician doesn't provide. The patient must pay the retainer plus insurance premiums and other plan obligations such as copays and deductibles. What lower income patient could afford such a model?
The model reduces the number of patients seen by the doctor. Typically, the doctor has a panel of 600-800 patients which is less than half the number for a traditional practice. Access to care would be reduced in the town where the doctor practices. Already there are too few primary care doctors and access is frequently difficult. This is a problem I am currently dealing with since the primary care physician I had been seeing left Bennington after only two years and no one has been hired yet to take their place. If widely adopted, we would need twice as many PCPs and this is nor feasible.
This model enriches the doctor at his community's expense. He collects a retainer ($1,650 x 600=$990,000) and in addition he may still bill the patient's insurance company.
Doctors certainly are burning out and looking for other models of practice, but this one would be harmful to the population. Thankfully, most doctors have rejected this model.
The other option he mentioned was a Healthcare Financing Account (HFA) or Healthcare Savings Account (HSA). This is an insurance option that is gaining traction with employers round the state. When I was still employed by the Southwest Vermont Supervisory Union, I looked into HFAs to make sure I understood this pre-tax account offers along with other private insurance programs. I was told that if you get sick and overspend your HFA, the additional costs would be "out of pocket " taxable expenditure. Again, this sounds like just another way for healthcare insurance companies to administer more healthcare dollars which consumers will have to pay for. Will this really result in cost savings to me or my employer? Will my HFA account be making interest for me or is my projected tax savings going to help balance these additional administrative costs? Where exactly is the benefit to keeping healthcare costs down? More questions, more confusion.
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