Doctors as “Insurers”? Caveat Emptor

January 4, 2007

Via InsureBlog we learn that doctors in the Houston area are providing something that is described as a form of “insurance coverage.” In fact, this article in the website is misleadingly entitled “Doctors Provide Health Insurance At a Lower Cost.”

While I’m sympathetic to doctors’ frustrations with managed care and recognize the importance of primary care, this is definitely not health insurance. Suggestions to the country – whether by the physicians themselves, brokers and other third parties, or careless journalists – could tempt people to unknowingly place themselves at serious financial risk.

The Houston plan allows people to pay $25 per month for the right to visit primary care doctors as often as they want, for a $10 per visit fee. Utilization trends will determine whether the doctors are making a real financial sacrifice, and time will tell whether physicians give these patients the time and attention they need (physicians sometimes undertreat patients that provide less revenue).

Still, underwriting issues aren’t as big a concern as the possibility that people will confuse this plan for real “health insurance.” If offers no coverage for anything but primary care treatment – and that’s not “coverage” as much as it is an agreed-upon discount based on an upfront free. Discounts on some laboratory and diagnostic procedures are also offered.

High-cost items such as prescriptions, specialist care, diagnostics, and hospitalization are all excluded. Those are the types of care that create the most financial hardship for the uninsured, especially lower-income working people who are excluded from Medicaid and other forms of assistance.

Said enrollee Marisol Buritica,

“My employer does offer insurance but it’s extremely expensive and I didn’t want that taken out of my paycheck, so this only being $10 a month, it was … affordable and I was able to have a primary care physician.”

While the plan’s website (Affordable Primary Care) states in passing that it is “not an insurance plan,” the Click2Houston headline reflects a confusion that’s echoed in Ms. Buritica’s own comments. “”I really wanted to be insured but I did forgo being insured for about seven months,” she said.

Ms. Buritica doesn’t seem to realize that she is still “forgoing being insured.” Dr. Jesse Chang, who created the plan, isn’t helping clear the air. “Not able to afford health care really should not be an excuse anymore for anybody,” he said. His plan is not a a cure for “not being able to afford health care,” except for primary care – which is one of its least expensive components.

Comments like that add to the impression that Ms. Buritica and the other enrollees are protected from financial risk due to health needs. She may find herself confronted with the need for costly treatments she’s not able to afford, which Dr. Chang may feel “should not be an excuse anymore” but remains a tragedy for millions of Americans.

This plan is really not much more than an adaptation of the Costco model to private payment for office visits. There may be a useful role for programs of this kind – but only if they are marketed clearly, effectively, and responsibly.

Marisol Buritica is still at risk. If neither Dr. Chang nor Click2Houston will tell her, someone else should.


2 Responses to “Doctors as “Insurers”? Caveat Emptor”

  1. Marisol Buritica Says:

    You are right. That group doesn’t even exist anymore.

  2. monk Says:

    Scary, it’s bad enough to get poor care from an allopathic physician, it’s worse to bring false hope of coverage. With a worse case sceanario health problem the patient is again mistreated.

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