Quality Health Care

How direct primary care can transform health care By Christopher J. Stadtherr, MD

Why is it that the USA is renowned for its medical breakthroughs and yet it remains the most expensive and lowest quality among developed countries?

While many are quick to criticize what little they know about health care in other countries, it appears that a concerted focus on quality primary care as seen in other developed countries can make an enormous positive difference in terms of outcomes, costs, etc.

In the United States, the system is structured to favor expensive forms of health care—urgent care, ER visits, and specialist care. Poor access to quality care has resulted in dependence on these expensive forms of care, which naturally rises leading to rising health-care costs.

Insurance does not equal health care

Using health insurance nearly always results in markedly higher expenses than if one were to pay cash.

An example: A patient was billed $5,400 for an MRI. The patient's health insurance paid ~$2,900, and the patient was responsible for the remaining ~$2,500. The same MRI was available down the street for only $725 cash.

Price transparency

Health care is notorious for not having price transparency. It is the only service that we routinely consume without knowing what it’s going to cost. Medical professionals themselves are unable to tell you what a service costs, because patients are charged differently depending on how you’re paying, including different negotiated rates for the various insurers.

Gatekeepers vs. physicians

Primary care in the US is largely a system of gatekeepers doing triage, managing only straightforward problems or ones that can be temporarily addressed with medication, then referring out anything more complex than that.

To physicians who are invested in quality care, “good health care” refers to having enough time with their patients to address problems thoroughly and appropriately. To health-care administrators, it has to do with meeting arbitrary metrics that have little bearing on actual patient care, but more so focused on revenue.

Where to find quality health care

Direct primary care (DPC) solves all of the above-mentioned problems. It is a model of delivering health care that prioritizes the patient-physician relationship without the bureaucratic interference of insurance-based care. Also, in the age of frequent data breaches affecting health systems, direct care is the best way to ensure privacy. Patients in direct care remark at the affordable, accessible, high-quality care that is available on-demand with their personal physician. They have learned that health insurance is what makes health care expensive.