The future of the Family Doctor and Primary Care
The complexity of the health care delivery systems in both the United States (US) and the United Kingdom (UK) means any meaningful change will only take place with simplicity in the patient-doctor experience. That begins with your Family Doctor in the US or General Practitioner (GP) in the UK. In the talk of new funding mixes within health care, the most critical aspect is often lost, that is the simplicity of a direct personal relationship with your Family Doctor or GP.
That will only occur through direct pay!
‘Going private’ as it is known in the UK is becoming an ever-increasing trend as ‘free at the point of service’ fails at getting to the point of service in a timely manner to see your GP, never mind any specialists you may need. Talk is now of introducing a fee (co-pay) to see the GP along with the established practice of a fixed prescription fee (GBP £9.35). In the United States visiting your family doctor with a health insurance co-pay is one thing, however, what the physician can do during the consultation is restricted to insurance codes indicating they will get reimbursed for their services provided.
How did we get here? And how do we change this?
Both health care systems have now fixated on the ‘system’ NOT the patient. So, trying to resolve the system failures while the patient suffers is only going to drive them into the private and direct pay sector. For the UK, we need to stop talking in vague, general terms about reforms. We need actual practical plans that include the introduction of personal/family/employee high-deductible insurance with the tax system reformed for direct pay incentives to encourage more. This can start at the Primary Care service level and expands its ability to offer more health services.
Expanding tele-health access could be offered directly to families and even their employers as they are increasingly being marketed through a direct pay for service or concierge (fixed fee per month) type approach. You cannot introduce this type of major change, of course, without consistently making the case for the open society and for self-responsibility, that does entail an understanding of what choices you do have to do so.
Let’s begin with pilot schemes with high-deductible insurance, to show people how it works with direct pay primary care services. You have to start with the things you can do immediately, so people can see that beneficial change can happen as a result of direct pay. That starting point is with your Family Doctor and Practitioner where the transformation in primary care can occur.
Given the constant opposition from single payor or free at the point of service advocates, such direct pay primary care pilot schemes could transform attitudes to what can then be extended locally, regionally and nationally in England, Statewide within the US with such an empowering approach to primary care services.
Dr. Raymond J. Davies, Ph.D.