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A theoretical study: Implementing a membership fee to replace standard health insurance in Logan County

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Introduction

Community health care is an important component to all communities and especially a under privileged community. I would like to discuss a new community health care policy for Logan County. The CDC defines “policy” as a law, regulation, procedure, administrative action, incentive, or voluntary practice of governments and other institutions” (2015). I would like to propose a policy incentive to the community, one that would involve a membership fee in place of standard insurance. Per the latest census, Logan County has approximately 29,527 residents and 4.8% of those residents under the age of 65 do not have health insurance. 9.3% of individuals under the age of 65 are on disability, which would mean they are covered by Medicaid or Medicare (2016). The census does not list the number of individuals on private or government insurance. I can only imagine how much the deductible is for those with private insurance such as Blue Cross Blue Shield. We all know deductibles are not cheap. My proposal is a membership-based healthcare clinic for Logan County.

Problem

Logan County currently has two options for basic healthcare. One is physician services and the other is Springfield Clinic. Between the two clinics, the total number of physicians for basic healthcare in Logan County comes to nine with two OBGYN physicians (2016). Logan County also has one hospital with an emergency room; however, this is not a trauma center. Abraham Lincoln Memorial Hospital is not listed as a trauma center; therefore, most patients are transferred to an area trauma center for more serious cases. The hospital can handle less serious patients which leads to much of either government-insured patients or patients without health insurance. This is because neither clinic in town will accept patients without insurance and several physicians do not except some of the governmental insurance plans. Between the two clinics in town there are nine total primary care physicians and two OB-GYN physicians.

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If dividing the number of residents of Logan County evenly per each physician that would be approximately 3,280 patients per physician. This number isn’t necessarily exact because we do not know the number of patients who see primary care physicians outside of Logan County. We can assume the figures are somewhat close as I used to work for Dr. Dennis Carroll of Springfield Clinic, and during my six years there his patient load was around 4,500 patients. There are several problems which can occur from this situation; one, the physician can become overworked by trying to fit upwards of 30-40 patients into his/her daily schedule, especially during flu season; two, it becomes hard for a patient to book an appointment due to the physician’s large volume of patients and overbooked schedules; and three, the physician must cut down on the amount of time spent with each patient which could lead to a multitude of problems such as a misdiagnosis due to being rushed.

During my time working for Dr. Carroll the lowest number of patients seen in one day was 20. If you all could just take a moment to imagine, the clinic opens at 8am, no patients are scheduled from 12 noon until 1pm and the clinic closes at 5pm. Now, each patient is scheduled in 15 minute increments unless special circumstances have allowed a longer time slot. If the doctor only spent 15 min with each patient and took an hour for lunch, and saw 20 patients, that would take him six hours. Seems perfect, right? He would have two hours to chart, so what’s the problem? Well, that 20 patient day rarely happens. It’s usually 30 patients and more than 15 minutes is spent with each patient, therefore, your 2:00 pm appointment gets pushed to 3pm or later and you are sitting in a waiting room full of sick people. Let’s look at another potential problem; insurance deductibles can be outrageous. HealthCare.Gov. reports a median individual deductible for HealthCare.gov Marketplace policies in 2016 is $850, down from $900 in 2015. However, they also show a graph indicating deductibles as low as $250 to $5,000 (2016). This becomes a huge problem for most individuals especially if you only go to the doctor a few times a year for minor illness.

Purpose

Membership-based healthcare is becoming a trend across the United States. There are different names and different ways of running a membership-based or cash-only clinic. Through my research, I found clinics that were cash-only with a monthly membership fee, and clinics which still billed a third party such as insurance but also had a membership fee-based clinic for basic healthcare, such as wellness visits or acute illnesses. Researching this topic gave me several ideas for a proposed solution for Logan County. What if the city of Lincoln had a membership-based clinic in addition to the two current clinics accepting limited insurance plans? I feel as if this would allow the individuals without insurance a more affordable way to receive basic healthcare as well as those who cannot afford their high deductibles. They can affordably see a physician for an acute illness without paying hundreds of dollars because they have a high deductible to meet before insurance will pay. The Physicians Foundation conducted a survey in 2014 of America’s physicians, one of the largest and most comprehensive physician surveys undertaken in the United States. Sent to over 650,000 physicians, or approximately 80% of all physicians currently involved in active patient care, the survey includes: “Responses from over 20,000 physicians in multiple specialties and in all 50 states. 7% of physicians now practice some form of direct pay/concierge medicine, while 13% indicate they are planning to transition in whole or in part to this type of practice. 17% of physicians 45 or younger indicate they will transition to direct pay/concierge practice” (2014).

Scope

Although there are many diverse styles of membership-based medicine, they all share common key goals, specifically to regain the joy of medical practice by restoring the physician-patient relationship, and quality of care through longer visits and increased physician independence. By giving up insurance billing, physicians can care for patients in a more compassionate and affordable manor. Listed below are some of the common elements of membership-based medicine I have found during research:

  • Monthly patient membership fees ranging from as little as $30 up to $150 or more
  • Unlimited office visits without co-pay
  • Visit times of 30 to 90 minutes or more
  • 24/7 access directly to physicians even nights and weekends (via phone or online)
  • Same or next day appointments
  • Minimal to no wait times for visits

These are only a few of the possible elements, the details and services are ultimately up to the physician running the clinic. The point is to have a basic healthcare clinic where individuals can choose to pay a monthly or yearly membership fee for unlimited physician acute care services.

Challenges

During my research on the topic of membership-based health care clinics, I conducted a survey on Facebook. This survey posed as a challenge as so many completing the survey did not answer the questions directly. Individuals instead expressed their concerns with such a clinic in Logan County. The total number of individuals who commented on the survey came to 50. Out of those 50, 25 individuals felt this type of clinic would be very beneficial for the community. The other 25 expressed several concerns and among those the biggest concern was the cost of membership. Individuals felt as if they could not afford much over 50 to 60 dollars a month. Another concern was how much it would cost to have procedures done or testing such as, MRI or CT scans and laboratory test. These concerns are valid however, I do not have an answer now. These are all things the physicians running the clinic would decide.

Similar Programs

Research has proved member-ship based health care clinics already exist. “Seattle-based Qliance Medical Management’s three clinics typically charge a patient about $65 a month for unlimited access to the practice’s 12 physicians and nurse practitioners. (Fees vary depending on the level of service and the patient’s age.) Office appointments last up to an hour and clinics have evening and weekend hours, with e-mail and phone access to clinicians as well. Routine preventive care and many in-office procedures are free; patients pay for lab work and other outside services “at or near” cost, and they get discounts on many medications” (Andrews, 2011). Another clinic opened in Lincoln Nebraska and operates about the same as the Qliance program. “Clients can often get same-day or next-day appointments, annual physical exams at no extra cost, wholesale costs for some diagnostic and in-house procedures and some common prescription drugs at very low prices” (Star, 2016). These clinics virtually can operate several different ways depending on the needs of Logan County and the needs of the physician.

Implementation

Implementing this type of clinic in Lincoln may be easier than it sounds. During research, it was discovered that Logan County is already in the process of setting up a new clinic. Through a phone interview with Amy Sikes from the Logan County Health Department, I discovered the Southern Illinois University School of Medicine (SIU) from Springfield IL. is interested in opening a clinic for low income families which will include dentistry at the health department in Lincoln (Olsen,2016). Amy stated the health department has six rooms already set up for patient exam rooms as the department used to see teenagers for birth control and sexually transmitted disease checks. This service is no longer available due to state funding. Amy mentioned the building has over 900 square feet available for use and as mentioned SIU is hoping to open their clinic in that space. I was not able to reach a representative for SIU but according to the Journal State Register the clinic will apply for government funding as a part of a federally qualified rural health clinic program. The other membership-based programs I researched did not mention any government funding however I believe this is something that would make the clinic more successful. I would like to ask the city of Lincoln to consider the idea of a membership-based program and discuss it further with SIU in hopes of reaching an agreement that satisfies the needs of all low-income residents of Logan County.

Conclusion

Low income families are a reality of Logan County, having a clinic that would provide services and basic healthcare would be very beneficial. The SIU clinic planning to take up the space at the health department has not mentioned including services for membership cost however, I urge the members of the Logan County board to discuss this when the clinic applies for their business license. I strongly believe the members of Logan County could lead better lives if basic healthcare at low cost would be available to them.

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