Retainer Services for Uninsured Persons

Concierge medicine has attained some market growth and notoriety.  This retainer-based practice of medicine has primarily been aimed at relatively well-off, often insured, persons who want more personal attention and has been adopted by physicians seeking more income stability, less administrative hassle and a slower paced practice style.  Now some physicians are exploring flat-fee medicine for the uninsured population.   (AMEDNEWS Article) (JABFM Article)

The American Medical Association’s news story describes some of these efforts in Rhode Island and in Florida.  In most of the arrangements, patients get a set number of visits for a flat fee paid monthly or quarterly.  Physicians may need to be a little careful because some insurance regulators may view certain forms of these arrangements as offering a health plan.  Patients seem very receptive and it is a particularly good fit for the many healthy young people who lack health coverage.  For these patients, the retainer coupled with catastrophic coverage, which is usually quite cheap, would be a far less expensive method of paying for health care needs than even the lowest tier health plan required under the new health law.

The Journal of the American Board of Family Medicine describes how two clinics which are part of the Oregon State University medical practice adopted a retainer program for uninsured patients.  In addition to the flat fee, patients may pay a per visit fee, depending on income.  Most of the patients who signed up were at the extremes, either having so little income they paid nothing or so much they paid a fairly full fee.  The practice found it actually got more revenue from these patients than it would for comparable services for Medicaid patients.

One lesson from this and other health care private sector innovations is that we may not have needed “reform” to fix some of the basic problems in the system.  A variety of inexpensive ways for patients to get basic care have been created by the private sector.  “Reform” is extremely expensive and may not do as good a job of meeting patient expectations, reducing spending and improving quality as these private sector solutions have.  Government also tends to get in the way and obstruct these developments, instead of facilitating them.