Uninsured patients respond well to paying a monthly retainer for primary care services
Research Activities, September 2011, No. 373
With so many uninsured Americans, creative ways need to be developed so that this underserved population can access primary care services and keep a regular physician. One solution is to apply the "concierge" or "boutique" approach to the uninsured, suggests a new study. Under this retainer arrangement, patients pay a fee every month to enroll in an academic family medicine clinic. In return, they receive office visits and can communicate with their providers via telephone and E-mail. A recent study found that those who participated in the program were very happy with it and satisfied with the care they received.
Called Access Assured, the program was implemented at two family medicine clinics in Portland, OR. Uninsured individuals wishing to make an appointment were asked to pay a fee of $25 per month for a minimum of six months ($150). There was a $25 discount if they enrolled for a full year ($275). In return, participants received unlimited office appointments, E-mail access to physicians, and the use of a prescription refill system. Charges for lab tests, drugs, and other services were billed on a sliding-fee scale.
For this study, Oregon Health & Science University researchers interviewed 40 program participants, including 20 who had renewed after their initial 6 months and 20 who did not. Patients reported liking how the program allowed them to select their own provider and maintain continuity of care. They also expressed appreciation for the program, felt like they were respected and treated the same as other patients, and were satisfied with the quality of their care. Some participants did not understand why they needed to stay enrolled if they were healthy, or were confused about benefits and services entitled to them. However, 11 of the 20 patients who did not re-enroll planned to do so at some future point. The study was supported in part by the Agency for Healthcare Research and Quality (HS18403).
See "Uninsured patient opinions about a reduced-fee retainer program at academic health center clinics," by John W. Saultz, M.D., John Heineman, B.A., Rachel Seltzer, M.A., and others in the May/June 2011 Journal of the American Board of Family Medicine 24(3), pp. 304-312.