Advantages and Disadvantages of Direct Primary Care—Reply

Abstract

To the Editor The Viewpoint by Dr Adashi and colleagues 1 raised several criticisms of direct primary care (DPC) that ignored the context in which DPC has emerged. Direct primary care has evolved in affirmation of the primacy of the patient-physician therapeutic relationship and rejection of bureaucratic and economic burdens on clinicians.The authors' suggestion that DPC practices promote adverse selection biases favoring wealthy, healthy, and nonminority patients relies on a false conflation of DPC and concierge practices. Unlike the dominant third party-based model or concierge practices that bill insurance, DPC practices relying on a flat monthly fee are not financially motivated to select patients based on health or socioeconomic status. In fact, DPC practices aim to provide as broad a scope of care as possible on the premise that individuals have the capacity to vote with their feet.The authors suggested that DPC would exacerbate gaps in the cost of care. However, out-of-pocket costs for mandated insurance products have ballooned for US households. 2 For many uninsured and underinsured persons, DPC practices are an economically feasible option that provides access to longitudinal primary care.The claim that DPC "lacks the necessary oversight needed to hold physicians accountable for data reporting as well as individual and population health outcomes" 1 is at odds with the central tenet of the clinician's fiduciary responsibility 3 -to place the patient's interests above others, including data reporting and population health outcomes.