Direct Primary Care, Concierge Medicine, and Self-Pay: Navigating the New Healthcare Models

Q: I’ve only recently come across the terms direct primary care and concierge medicine. Are they the same? And what does self-pay healthcare refer to?

A: Our recent posts on direct primary care (DPC) have been very popular, in large part because so many are searching for ways to secure access to affordable healthcare. Prevention is the key, but that’s very difficult to do when the cost of insurance premiums can block access to care.

Our changing healthcare landscape is intriguing. Many articles that mention DPC also reference concierge medicine. Some sources treat the models as being interchangeable, but there are significant differences.

Simply looking at the names points to one of the differences. Let’s have a look to help clarify the confusion.

Direct Primary Care

DPC means that you work with a primary care doctor directly. Neither the patient nor the doctor work with insurance for the delivery of services. (DPC) is essentially a membership plan for your medical care. You sign up on a monthly, quarterly, or annual basis. In addition to gaining access to a primary care doctor, you can obtain clinical and laboratory testing as well as other services.

The benefit of this form of care is that it allows doctors to deal directly with patients and get out from under the bureaucracy of working with large health insurance companies. The time that doctors don’t have to spend dealing with insurance allows them time to spend more time with their patients. It also allows access to appointments for those who might otherwise be unable to afford medical care.

While DPC is a great option in many ways for providing affordable healthcare, it does not cover everything. You should also have a high deductible plan to cover any expensive and unforeseen treatments that may be required to ensure that you have some form of coverage.

Concierge Medicine

What do we think of when we think of the word “concierge”? Most likely someone at a hotel who specializes in providing an extra level of service to guests–for a price. It is a very similar notio in medicine.

One significant difference between this model and DCPC is that concierge doctors often accept insurance. However, these services often charge more than what is covered by insurance in order to provide quality add-ons to patients.

With concierge medicine, you pay more to get more, including more time with your physician and access to premium services. Similar to DPC plans, those who opt for concierge services pay a membership fee that allows them to more services and time with their doctor to maximize their coverage.

There are distinct differences between the DPC and concierge medicine models, but the reason for the rising popularity of both is rooted in the same cause. Existing insurance plans are not available to or working for many, doctors and patients included.

Self-Pay

Self-Pay is not a term to describe a certain kind of plan or model. It literally means that the patient is paying for their own care. They don’t use insurance, or DPC, or concierge medicine. They are paying their costs out-of-pocket.

Why would you do this? Is this for people for whom there is no other option?

Actually, it’s not. According to Consumer Reports,

A growing number of medical services, from MRIs to blood work to outpatient surgery, could cost you less—sometimes a lot less—if you pay the provider out of your own pocket and leave your insurer out of the picture.”

As the article notes, this is particularly the case for many who have high deductible plans. Some facilities offer significant discounts to those who cover the cost upfront, making self-pay an attractive option for some.

Your health is too important to leave to chance. The healthcare landscape is changing, which presents some real opportunities for folks like small business owners looking for coverage. Research your options, and find the best option that allows you access to the affordable, preventative care that we all need. If you are managing a chronic illness, than you will need to be mindful of how to realistically get the treatments that you need.

Do you work with a DPC physician or tried concierge medicine? We’d love to hear from you to hear about your experience.

Photo by Marcelo Leal on Unsplash

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