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A Pioneer in 'Flat-Fee Primary Care' Had to Close Its Clinics
- RcouF1uZ4gsC 9y agoI think there is a selection effect. It mentioned that losing some of it's large corporate customers was a big issue. When you sign up a bunch of employees that get this service through their employer, chances are good that most of the people will underutilize the service - thus you have a good profit. If you lose that, and now a lot of your customers have subscribed individually, there is a good chance that they will overutilize the service - after all they paid good money for a reason. Thus your profits will decline.
- deleted 9y ago[deleted]
- mjevans 9y agoI suspect that reason might (often) actually be that they are in less than average health and selecting the correct 'plan' for them. The insanity is forcing patients to compete for health plan coverage. We'd all be better off with a single payer system and locality based dutch-auctions for figuring out who provides the care. Also, can I please have Dr. Watson (or similar) take actual inputs and determine if further tests are necessary to confirm or reject a diagnostic result? I still want an actual doctor to make the final check on the results, but I'd rather have an algorithm make the guesswork less dependent on one person knowing -everything- (that's what computers are for).
- tpeo 9y agoWhat you're describing looks a lot like adverse selection.
- douche 9y agoWhen people have skin in the game, they make different decisions than when they are spending other people's money.
- lotharbot 9y agoas a patient, Qliance was a phenomenal experience, and easily worth the cost. (I no longer live in the area, but am with a DPC practice where I am now, which is of similar quality.) I wonder if the problem with losing their big employers was that it changed their patient demographics too sharply and suddenly.
- esaym 9y agoIf they are talking about "direct primary care", then there are still plenty to choose from: http://www.dpcfrontier.com/mapper/ http://www.dpcfrontier.com/mapper/
- Animats 9y agoKaiser offers "flat fee primary care", and they do OK. But they have experience at running that kind of business.
- narrator 9y agoI love Kaiser. They are so ridiculously efficient compared to all the other health care providers I've had over the years. Doctor's being salaried and paid by the hospital and the hospital chain being the insurer is really the way it should be everywhere.
- oldandtired 9y agoA former travelling companion (on a long distance train trip) moved from Head of R&D for an advertising agency into working in the medical technology industry. After six months or so, he returned to his former job of head of R&D at the advertising agency. When quizzed by the staff at the advertising agency as to why he came back to such a corrupt industry. His comment was that advertising were little children in terms of corruption compared to the medical technology industry. I had a long discussion with him about what he had seen. He made the statement that every company that he saw would increase their prices for any product that was being sold into health care by at least a factor of 10 over what they would sell the same product for to non-health care areas. I, myself, have had other conversations with various people (in both drug companies and medical institutions) and it has been common for comments to be made as to the vast difference between drug production costs and the final retail sale prices (even taking into consideration all the development costs, I have seen some of these figures and they are, well ....). Health care is as exorbitantly priced as legal consultations and representation and the value received is in many ways far less than what you would receive by going to Macca's.
- kingkawn 9y agoStraight up exploitation of people during their most vulnerable moments.
- fredley 9y agoThe free market is a poor model for providing healthcare. In an ideal free market, market forces work to find the optimum price for a product, depending on how much it costs to create the product, and how much people are willing to pay for it. In healthcare, though, how much people are willing to pay for a product is anything, if it's the one thing they need to stay alive, or to reduce chronic pain, etc.
- patrickg_zill 9y agoWe don't have a free market in healthcare. Easily proved by looking at the artificial barriers to entry, both for products and people.
- TuringNYC 9y agoAnyone have insights on how Go Forward Health (https://goforward.com/ https://goforward.com/) is doing? I love their concept, to the extent I almost want to work there. However, I wonder if such services would suffer from an adverse selection problem -- their current cost of $149/mo seems almost free these days -- how do they manage high-volume users?
- jtokoph 9y agoJust took a tour of the facility a few weeks ago. During the hour (or more?) we were there, nobody came in or out. I think their issue is just getting users at all; so high-volume users would be a great problem for them to have at this point. They are trying to sell users on the fact that they are a tech company just as much as a medical service. But from what I saw they have a "Body scanner" (glorified scale that also gets height, O2 and pulse) and a bunch of iPads built into the walls. EDIT: Also wanted to mention their trickery with pricing. They bill annually. The rep will tell you that they have a special promotion where you can sign up for the monthly plan if you sign up shortly after your tour. But the "monthly" plan still requires you to pay an early termination fee of 50% of the remaining annual balance.
- Simulacra 9y agoI wonder if unlimited consumption because it's unlimited is more of an American phenomenon. Everything from buffets to unlimited mobile useage, we seem to really love unlimited and we use it pretty aggressively when we can. I wonder why this clinic did not put some controls on things; please correct me I did not see that in the article.
- alkonaut 9y ago> "some health care analysts are questioning whether the approach to medical care is valid and viable." Perhaps just stop trying to figure this out from scratch, look at any of N countries where healthcare is just a solved background issue? Yes there are issues with people overusing services that don't have an associated cost for usage, and many similar issues. But every damn country in the world has been adjusting the parameters of healthcare such as per-visit costs, healtcare budgets vs. queue time, expensive treatments vs death-panels etc for usually at least half a century now. These are solved problems.
- Shivetya 9y agosure, but the politicians and such here don't want to solve the problem, or should I say follow the example of other countries. They will regularly cite other countries of how we are failing then comes the litany of "buts" when confronted with issues seen in those countries. The "but litany" is how their solution will fix all raised issues or provide coverage not seen elsewhere for less and better. which in the end results in nothing getting done as the problems cannot be agreed to. so its mostly hyperbole to claim it is a solved problem. even in nations with free healthcare problems exist, it just depends on what you want to ignore as a problem
- refurb 9y agoI come from Canada and I would say healthcare is not "solved" by any means. There are constant struggles with wait times, growing budgets and allocation of limited resources. There is no magic solution. I do agree that the US should look to other countries for ideas though.
- alkonaut 9y agoWell it depends on the definition of "solved". Having a system where people have access to decent healthcare and it doesn't ruin public finances I mean. I keep twisting the thermostat a bit but I consider building heating to work in the "solved problem" sense Public healthcare will never be perfect.
- timthelion 9y agoMeanwhile in the Czech Republic, for caa 50$ a month (for a person making minimum wage, it's double that for median wage workers) there is no copay on anything and the insurance covers everything including sex change surgery (but not facelifts and dental)...
- vxNsr 9y agoI always chuckle when I see people compare what amount to 3rd world countries with the US system, my mother was trained and worked in Moscow's largest hospital. The shenanigans that went on there, the level of training and expected knowledge of staff, the baseline expected standard of care all don't even hold a candle to what she had to reach to be considered competent in the US. On top of that I don't know if this applies to CR as much as other European countries, but homogeneous populations really are easier to care for and create actuarial tables around than the stew of the US; when people bring Sweden with its <50 million pop of white people with very similar ancestry to prove their method might work, they ignore how medicine and the whole industry actually is practiced (and needs to be practiced). Let's wait 20-30 years now that they've taken in 1.5 million refugees from a very different background who are projected to grow 3x faster than the current population before we start trying to emulate unproven theories.
- germanier 9y agoThen take a look at other countries: The German system was introduced 130 years ago[0], survived multiple forms of government, two world wars, the incorporation of a former socialist country, multiple waves of immigration, and still provides excellent care. It just works. (And modern medicine is not yet at a level where ethnicity is a relevant factor when deciding treatment options.) [0]: By highly conservatives by the way, to fight the rising social democrats
- timthelion 9y ago> (And modern medicine is not yet at a level where ethnicity is a relevant factor when deciding treatment options.) Perhaps OP was refering to the fact that the decendets of slaves in America are MUCH less healthy than the rest of the population.[1] [1] http://archive.independentmail.com/features/columnists/what-specific-health-concerns-exist-for-african-americans-ep-411884270-348754091.html http://archive.independentmail.com/features/columnists/what-...
- dr_ 9y agoThe affordable care act has enrolled millions on to some kind of health insurance plan. Even if you are stuck with a high deductible plan, oftentimes that annual check up (preventive care) is fully covered without requiring a deductible payment. And, of course, if you are on Medicaid - you have Medicaid. If you are relatively young and/or healthy, that's all you would really need. As a result, their patient population likely gradually dwindled. I was a proponent of dpc at one point but, now enrolled in a high deductible plan myself, i don't see as much need for it personally. I'd rather take the money and throw it into my health savings account and use it when i need to.
- distances 9y agoBeing from Europe, the concept of annual check ups sounds very wasteful. Is this what everyone does in the US? As far as I see it, schools should teach enough to keep you in a good baseline health and doctors are available if something comes up. What is done in a normal annual check up?
- lr4444lr 9y agoThey test for the symptoms of serious chronic health issues: blood pressure, urinalysis, blood sugar, cholesterol levels/ratios, joint reflexes, retina appearance, manual check for swollen tissues... things that might signal underlying conditions.
- losvedir 9y agoWow, I had no idea this wasn't a universal thing! Thanks for asking the question. From some brief Googling, it seems Canada also recommends against an annual health check, and I saw an article in NYTimes arguing against them, too. Fascinating.
- DBNO 9y agoFor me, I use my annual checkup to get data (i.e. lipid and comp panels, etc, hearing test, electrocardiogram, urinalysis) on myself so I have a baseline of what the data looks like when I'm healthy. Everyone has slightly different baselines, so it's nice to have a better picture/time-series of mine. Edit: I pay for the additional blood panels
- ada1981 9y agoYou may want to screen / sort customers based on Attachment style.. it's been found folks with anxious attachment visit the doctor more often and use more resources - but they visit for things that are non-issues, basically they are going for the relationship.
- timthelion 9y agoIn Czechia, where there is no co-pay, for a while, a co-pay of $1 was instated, not to help pay for services, but to "prevent seniors from comming just to chat".
- ada1981 9y agoYou may want to screen / sort customers based on Attachment style.. it's been found folks with anxious attachment visit the doctor more often and use more resources - but they visit for things that are non-issues, basically they are going for the relationship.
- deleted 9y ago[deleted]
- driverdan 9y agoA recent EconTalk episode covers the history of this type of system in depth: http://www.econtalk.org/archives/2017/06/christy_ford_ch.html http://www.econtalk.org/archives/2017/06/christy_ford_ch.htm... It was widespread until insurance companies forced them out of the industry.
- ams6110 9y agoIf a straight fixed fee was encouraging people to overuse the service, why not tweak it and try a fixed base fee plus a modest per-visit fee?