Baby boomers, and those who like to watch vintage TV programs, may remember watching Dr. Welby, MD. Dr. Marcus Welby was a family practitioner who worked out of his home office. He and his young, handsome partner, Steven Kiley (played by James Brolin) were able to solve medical emergencies and lingering health crises in 30 minutes (minus time for commercials) every week. There wasn’t much dialogue about insurance coverage or claims examination on the show. Patients gladly paid the doctor for his services by cash or check.
Dr. Welby, or the show’s creators, were ahead of their time. With the changes in medical insurance coverage still a mystery, one solution for the healthier population segment may be the return of Dr. Welby-style medical services in the form of concierge medicine. An article in Forbes, “Concierge Medicine As A Replacement for Insurance,” goes so far as to say that concierge medicine could replace medical insurance for some patients.
Why pay ever increasing medical insurance premiums with high deductibles for fewer services? Instead, concierge medicine bypasses the insurance company. Patients pay a monthly retainer to the doctor, much like you would a business consultant, accountant or attorney. When you need a doctor visit or other covered service, just make an appointment. If you’re healthy, the monthly retainer ensures you’ll have access to your doctor if you need it
Sounds like a simple process. The article suggests it could be a way of making family practice more profitable for the medical students trying to decide on a career choice and the best way to pay for their student loans obligations. Specialty medicine is more profitable. But if doctors were collecting a sort of monthly premium from all patients regardless of their health or service utilization, they may be more inclined to choose family practice. Doctors could manage patient load and build a practice. Patients wouldn’t have to go through the hassle of insurance claims, frequent changes in employee benefit providers and ever changing levels of covered procedures.
This works well if a patient is relatively healthy. The problem arises when someone has a serious health issue. Cancer treatment or a hip replacement can be costly, and not part of the “concierge” services. Hospital stays, extended nursing care or rehabilitation are extras that would have to come out of pocket as well. To guard against financial ruin, individuals could opt for a form high-deductible, low-premium catastrophic insurance coverage. Since the Affordable Care Act takes away the exclusion based on pre-existing conditions, individuals may be able to coast along and only get the catastrophic coverage when it’s needed.
Concierge medicine could have an impact on the future of insurance coverage and force insurance companies to consider alternative plan designs and premium costs to keep enrollments up. No doubt the ACA will make medical care providers, insurance companies and individuals reassess their needs and options. The industry will need to be creative with insurance plan options as quickly as the marketplace finds alternatives to traditional health care delivery and service methods.
Photo Source: Freedigitalphotos.net
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