Comments on: Cash-only primary care

By: Anonymous

Anonymous — Sun, 20 Jan 2008 02:50:00 +0000

The indigent patient who tries to make his financial problem his doctor's problem by complaining that he can't afford to see a specialist is really 1. refusing recommended evaluation and treatment and, 2. attempting to evade personal responsibility for his circumstances by muddying what should be a clear understanding that referral is necessary and not to be bargained away by pleading poverty.

Neither prevents a primary care physician from offering cash-paid service at a discount. You do have to make it clear at the outset that you do not offer specialist services and that any recommendations to obtain services are made with the expectation that the patient will have to make their own arrangements.

It works for doctor-staffed urgent care clinics.

The doctors who have the biggest problems with this are those who are not clear in their own minds about their own role vis-a-vis their patients. Doctor, not social worker or crisis counselor or charity project worker.

By: Anonymous

Anonymous — Sat, 19 Jan 2008 01:43:00 +0000

I don't see how the primary care doctor somehow "owns" the specialty care legally because the patient will not get recommended care.

Agreed, though, people can sue for just about anything. So heck, I'm sure someone would try.

But if so, you could say the same thing about providing primary care services to Medicaid. We always have problems referring those patients. Then there's Tricare. More and more often, Medicare.

And by that logic, we're "stuck" with dental complaints on quite a few patients, considering how often I hear people complain about dental access.

By: Anonymous

Anonymous — Sat, 19 Jan 2008 01:30:00 +0000

It seems like this might be a compliment to a high deductible major medical policy.

But the example family who passed up MassHealth for their children suggests that affordable cash care works against the goal of mandatory coverage. The state needs people to carry major medical so when they have big expensive problems they have coverage.

By: Anonymous

Anonymous — Fri, 18 Jan 2008 20:09:00 +0000

What happens when the patient needs more than primary care and pleads poverty, leaving the primary care doctor “stuck” with a situation beyond his or her capability. I once had the bright idea of offering to see an uninsured patient for $25 cash. After one patient came in for chest pain and stated he could not afford to go to the hospital or pay for any other tests, I realized that this was not going to work. Primary care practitioners cannot offer discounted services in isolation from the rest of the medical care system. It’s too much of a liability risk.