SEPTEMBER 15, 1999

Editorial

To Serve the Uninsured, Physician Suggests a Simple Plan

 What can physicians do to solve the problem of providing care for 43 million uninsured Americans? These 43 million represent 17.6% of the population and most are not the poorest of the poor, who tend to be covered by Medicaid. Approximately 75% work part-time, but are not offered insurance through their employer. If insurance is offered, it may come at a cost they choose not to pay, according to The New York Times. As the cost of health care rises sharply this year, more Americans will be left without health insurance.

Seeking to address this abysmal situation, David McDonald, MD, a family practitioner in a three-physician primary care group in Renton, Wash., formed the American Association of Patients and Providers (AAPP), which has developed a solution of its own. Three years ago, the group launched a plan called SimpleCare.

The AAPP says as much as one-third of the high cost of health care can be attributed to the overhead required for billing insurers, a problem managed care has exacerbated. Under the SimpleCare program, participating physicians would give participating patients a lower price in return for a cash payment at the time of service.

"Many patients would pay 30% to 50% less when the administrative burden is removed from the equation," according to the SimpleCare plan. "Without the administrative red tape, providers have more quality time to spend on each patient's health care needs."

For a family practice in Renton, for example, a typical insurance charge of $79 would include the cost of billing, rebilling, and complying with regulatory requirements. This charge can be cut to $35 to $45 when a patient pays for the service at the time of service, according to the SimpleCare plan. Physicians would charge $35 for a short visit of no more than 10 minutes, $65 for a visit of as much as 20 minutes, and $95 for visit of an hour. The program would work best for those people who have catastrophic health insurance coverage or who are in a medical savings account, the AAPP says.

While few patients without insurance can afford individual policies or high monthly premiums, many can afford to pay a discounted fee for a valued service. The benefits for patients are many. They are free to choose their own physicians, they don't have to worry about paying more for pre-existing conditions, and all services are covered.

Physicians would realize increased cash flow and expenses would fall as a result of fewer administrative requirements, AAPP says. What's more, the plan puts health care providers back in charge of the care delivery system by allowing them to set a reasonable fee for professional services and to get paid quickly and without the administrative hassles of billing insurers, many of which are notoriously slow to pay.

SimpleCare is not a universal answer for the problems of the working uninsured, but it's a start, and the benefits for physicians are difficult to ignore. In addition to improving cash flow, physicians experience less trouble with insurers, and they are back in charge of the health care system. For physicians, this last benefit may be the most appealing of all. To learn more, visit www.aapp.net or www.simplecare.com.

Richard L. Reece, MD -  Editor-in-Chief    888-457-8800   Rreece1500@aol.com