Medicine as a subscription service?
But the goal is to get better and leave healthcare behind.
Having a personal doctor who is available for quick texts or calls 24/7 can be a helpful service, but I don’t see it becoming the norm for most people. Why would someone need a personal doctor for much of their life?
Direct primary care is a relatively new model that provides patients with a monthly subscription fee of around $100-$200. This model offers benefits such as unlimited access to physicians, at-cost and transparent pricing for diagnostic testing, and usually doesn't involve medical insurance.
While there are a few cases where having a personal concierge or DPC doctor could be beneficial, such as end-of-life care, acute illness, or significant health events like heart attacks, cancer, or hip fractures, it doesn't make sense for most patients to have a doctor on call indefinitely. For these situations, a responsive doctor may be helpful for a limited time of a couple of months to a year or two at most.
The goal for most patients should be to eventually not need a doctor. Unless the doctor is serving as a health coach and providing counseling on how to eat, cook, and lift weights, most patients would not find a subscription doctor service valuable indefinitely.
For example, a patient with newly diagnosed type 2 diabetes could benefit from tools to control their diabetes with diet and exercise, possibly without medication. Nothing is more satisfying than seeing a patient who has dropped their sugar levels to normal ranges without medication. After a while, these patients can graduate and no longer need to see the doctor. They have learned how to take control of their health and regain their freedom from disease and the doctor's office.
The subscription model creates tension. The ideal patient is one who is healthy and never makes an appointment while remaining a subscriber. This incentivizes the doctor to get the patient well. However, once the patient improves, what reason do they have to continue paying a monthly fee? As such, these practices have procedures in place to prevent patients from leaving and returning.
Nobody wants to be sick forever or go to the doctor's office every three months. Patients who feel they need frequent doctor visits may need to address the root of the problem, and more access to the doctor is not the solution.
While some DPC and concierge models thrive, it's possible that patients would prefer to come in for sick visits as needed rather than paying a subscription fee. Perhaps there's a better way to align the incentives of the doctor and patient.
My initial thought is that life is a whirlwind of unexpected happenings so DPC subscription is not such a bad idea. However, practices that prevent coming and going may lose patients for that very reason - I think as this model becomes more popular there will be more options for patients.