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The role of direct primary care for the uninsured

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Insurance premiums and deductibles are on the rise. Many people appear to be frustrated with the debates and difficulties surrounding the Affordable Care Act (ACA). Health insurance has become a complicated and often unaffordable purchase for a number of people. The number of uninsured adults in the US has increased to 11.3% in the first quarter of 2017, up from 10.9% in the third and fourth quarters of 2016.

Many of those uninsured cannot afford regular health insurance premiums and may not be eligible for coverage under the ACA. Direct primary care (DPC) offers an alternative healthcare practice model for the uninsured. The DPC model operates on patient membership fees, rather than insurance reimbursements. Patients pay a regular monthly fee that may range from $35 to $100, which covers most basic services.

Patients may develop a false sense of security, however, in being able to access a range of services for their membership fee. Although DPCs do not generally accept health insurance for their primary care services, DPC physicians often encourage patients to secure catastrophic insurance for services that are not covered in their membership.

The preventative care that patients can receive at a DPC practice is crucial to detecting and providing care for potential healthcare issues in the early stages. Most practices include follow-up communication in their services, so patients are able to ask questions or request clarifications outside the office visit. The DPC can play a significant role in early diagnosis and prevention of potentially catastrophic illnesses.

When those catastrophic illnesses require additional treatment, though, the costs can be devastating for patients who do not have the appropriate insurance coverage. Patients with chronic conditions, in particular, may require multiple visits with specialty providers and those visits are not covered under their DPC membership fees.

DPCs provide a positive alternative to the traditional insurance-based provider. However, DPC should not be considered to be a form of insurance. Rather, the DPC membership fee covers the basic services provided by that particular physician. Catastrophic insurance is generally also recommended by DPCs.