Question: Is it possible to form a co-op between doctors and patients?

[peacebird]

I have been wondering if there is a direct action that can be taken to cut out the middle man (insurance companies) for routine medical care, and just carry major medical insurance for the big stuff that might happen. Kind of like the CSA (community supported agriculture) idea where you pay a monthly fee, accept part of the risk of crops failing to thrive, & get veggies grown locally... I do a similar thing with local farmers for poultry and meat.

Would such an idea work for doctors as well? With what I pay for insurance each month its not like the doctors would take a cut in salary.
Has anyone heard of similar ideas?

[Mend]

1. Several doctors in my town do what is called a "boutique" practice....they

will answer the phone themselves, see you within 24 hours 7 days a week for an annual fee ranging from $3000 to $5000. These doctors specialize in internal medicine. This fee doesn't cover lab and hospital costs or medications. Each doctor who does this limits his/her practice to only 500-700 patients. It is very personalized service but major medical insurance for in-patient and other medical specialists would be necessary just in case.

[triguy46]

8. This is a growing trend. A true 'private' practice. If you had a MSA it could work well.

[Mend]

9. I know self-employed people with conditions like diabetes who can't get

health insurance who do this. And at about $400 a month, they are getting a good deal. They are often seen the same day and that helps prevent more serious complications. The one pediatrician who tried boutique went traditional in one year...but he was making house calls and it was time-consuming.

[Mayberry Machiavelli]

2. But if you're already paying for a regular policy, wouldn't this just be an extra expense?

If you did your whole coverage this way, the "coop" would eventually become its own insurance company or HMO, that's how that whole industry started.

[knitter4democracy]

3. There's a movement amongst doctors to not take insurance at all.

They don't do malpractice insurance, either. They've figured out exactly which fees to lower, and they take payment from patients only. Some insurance companies are reimbursing those patients afterwards, but not all do. There was an AMNews article last year about it.

[Mayberry Machiavelli]

5. Whether or not the doctors choose to insure against malpractice is a separate issue from

how they are reimbursed, as far as I can see. Engaging in a coop or capitated arrangement with patients in no way prevents them from being sued, no matter what waivers a patient may sign. Unless the doctors pool their money to represent a fund to pay out any lawsuit judgments or settlements (feasible if the group is large enough), which is itself a form of insurance.

These must be primary care doctors, because there's no way most hospitals or facilities with operating rooms would allow surgeons privileges to practice there without having liability coverage of some sort, unless the facility they work in is completely owned by the doctors (rare, usually even "doctor owned" facilities are bankrolled in large part by a big parent company), or again, unless the doctors had some kind of pooled arrangement which would represent self insurance by the group.

[knitter4democracy]

6. They are primary care docs.

They're using hospitalists for hospital coverage, mostly to avoid the malpractice. Some hospitals have a minimum amount required, so the doctors save up and put that in a special account that they don't touch. Then, if they are sued, that's the account they use. I forget the name of it, but it's all set up through lawyers and such.

[Mayberry Machiavelli]

7. That is a form of self insurance, you just pool the money yourself, or among your group,

rather than have a separate company do it for you. I worked in a practice that did this once. It's a cheap way to insure, until or unless your group gets hit up with a few million dollar judgments.

[knitter4democracy]

10. True. Some are finding it works better. nt

[On the Road]

4. I Like the Idea of Entities

that are not organized around the model of a profit-making corporation. I think there's a big opportunity there.

Health insurance involves many different specialties, lots of risk and potentially lots of money. It may be too large an enterprise for a group of local doctors and patients to begin.

Something like this might begin as a self-insurance mechanism for a large association. But it would have to have the kind of culture to forego profits, otherwise it could become just another insurance business. Something like a National Geographic, Smithsonian, or AAA.

[seemunkee]

11. My former doctor did something like this

He quit his group practice and went out on his own. You pay a set yearly fee and have unlimited access to him cell phone, home phone, email, office visists. He makes house calls and will drop off prescriptions for you and has limited the number of patients he will take on.
I couldn't afford to stay with him and had to switch. I see him around town and he is very pleased with how things are going and happy to be able to practice medicine without all the restrictions of dealing with insurance companies.