Skin in the Game

It has been always mentioned here that our healthcare system can only be saved if patients have some skin in the game.  Mainly that means taking care of themselves (eating right, exercising, not drinking or smoking, etc).  Another definition is when they pay for their own healthcare out of their own pockets and subsequently eliminate third parties except for catastrophic care.   This a cash-pay or a direct-pay model.  Still another definition is for employers to allow their workers to pick the insurance products they want understanding that they may have higher deductibles, etc.  In other words, they could pay less yearly but would take the risk of more coming out of their pockets.   This was just illustrated in an article in the WSJ and guess what?  When people spend their own money they tend to be cheaper.  The example included “employer-centric marketplaces, known as private exchanges, are separate from the public exchanges created by the federal health overhaul law, which will be set up by state and federal governments. However, the public exchanges, serving individual consumers and small businesses, will operate on a similar principle of allowing people to shop for health coverage in an online marketplace.”  In other words, most people are going to go cheap once these public exchanges are available as well.    What this means is anyone’s guess.  Will people stop using doctors as much because more is coming out of their pocket?  Probably.  Will this open up opportunities for direct pay models?   I don’t know the answer to that.  I only know that since Medicaid patients still have no skin in the game, they will be crowding the ER as much as ever.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Skin in the Game

  1. J. R. Johnson
    March 28, 2013 at 5:54 pm

    “…our healthcare system can only be saved if patients have some skin in the game…”. What are your priorities, saving the healthcare system or helping patients? Unfortunately the current systems is at odds with helping many patients as was documented in the last authentic medicine’s link to the Time article on healthcare costs. I have a small trickle of patients who have had to forgo life saving diagnostic tests and treatments due to cost concerns. I fear if we save the healthcare system in it’s current form, the trickle will turn into a flood.

    • Doug Farrago
      March 28, 2013 at 6:02 pm

      I think you have to help each individual while also trying to be a steward for the healthcare system. A delicate balance that only doctors see.

  2. Kurt
    March 27, 2013 at 10:23 am

    No shit Sherlock. Not a damn thing is going to change in this country until the participants are held liable for their behaviors.
    The poor med students who are falling for the primary care pablum of “cradle to grave” or “there is going to be a need for more primary care providers as the country ages” are going to be the dissatisfied practitioners down the road. Cripes, FP is getting kicked out of hospitals in favor of hospitalists “who can expedite care” and NP’s are going to be taking over the office care situation and compete with MD’s. I know because I supervise one who is good and could very well work on her own without me.
    The “electronification” of medicine has created a monster of so much
    “uncompensateable” paperwork that one hardly has time to see, examine
    and instruct patients anymore. My income has never achieved parity of the “teaser” salaries given to newcomers. Of course that is partially due to my practice (d)evolving? into a geriatric one. That takes more time and results in less production. The thing now is due to the paperwork aspect, there is piss poor free time and I’m working more hours getting paid less.
    I can go on. One thing about electronification is that medication lists and mistakes are more rampant. Yes more rampant. People don’t keep track of their meds anyways and they are changed around in outside places. One f—ing mouse click and an error can be propagated in a split second. Also when nursing staff called pharmacies to refill patients meds,our pharmacist colleages would point out discrepancies. Now they get a fax or “eprescribe” notice and assume any change is suppose to be intended. The future looks grim for a primary care practitioner and I do not recommend it
    to med students. The FNP’s will get disgruntled down the road and I foresee them abandoning the profession once they are faced with all the BS paperwork the MD’s don’t get paid for doing. (In the states where the NP’s have to work with the physician, the doc ends up signing a the paperwork that goes with the NP’s patients.)

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