Direct primary care provides medical treatment the old-fashioned way | Opinion

Because of the way health care has evolved in the United States over the past 80 years, it is extremely complex and now involves employers, the government, and various insurance companies.

Yet, health care is simply an economic activity, albeit where the activity between a provider and a patient is the most personal interchange an individual will ever have. However, because of the complexity, the vast majority of patients in the U.S. don’t completely control their medical finances and, in many cases, their medical decisions.

Almost 90 percent of Americans have their health care provided through their employer or the government via Medicare, Medicaid, and Obamacare. Likewise, health insurance companies often dictate what medical procedures or medications are allowable.

Direct primary care (DPC) changes that entire dynamic. There are some minor variations, but in its simplest form, DPC is a contract between a patient and a primary care physician. The patient usually pays a fixed amount of money per month and then has unlimited access to the medical provider for routine types of care. There is no insurance or government involvement. Most practices limit the overall number of DPC patients they will accept.

From the patient’s standpoint, DPC offers real continuity of care and allows the provider to develop a meaningful relationship with the patient. From the primary care provider’s perspective, there is an opportunity to really get to know their patients, there is an average savings in overhead of around 40 percent, and the provider has the ability to practice medicine without interference from any third party.

The number of DPC practices is growing, going from 100 in 2009 to over 2,500 in early 2025. A patient in a DPC practice still needs to have a major medical or catastrophic health insurance policy to cover hospitalizations or other large medical expenses. In this case, insurance functions as it should to pay for infrequent, unpredictable events rather than day-to-day medical expenses.

Half of all Americans receive their health insurance through their employer or their spouse’s employer. To save costs, there is growing interest among employers to utilize DPC for their employees. Likewise, there have been DPC practices that limit themselves to the Medicaid entitlement population with initial success. Seniors in the Medicare program have the ability to access DPC as well.

Although attempts have been made by state insurance commissions to classify DPC as health insurance and to then regulate it, these attempts have been unsuccessful. By any definition, DPC is clearly not any type of insurance.

Health care costs and expenses continue to increase in the U.S. Direct primary care is an excellent tool to hold costs down, while giving patients more control over their health care decisions and dollars, and giving providers more freedom to practice medicine without third-party interference.

Dr. Roger Stark is a visiting fellow with Mountain States Policy Center, an independent research organization based in Idaho, Montana, Eastern Washington and Wyoming. Online at mountainstatespolicy.org. A retired surgeon, Dr. Stark has authored three books including “Healthcare Policy Simplified: Understanding a Complex Issue,” and “The Patient-Centered Solution: Our Health Care Crisis, How It Happened, and How We Can Fix It.”

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