What if someone were to start a "pay what you can" chain of primary care clinics?

[Roland]

These clinics would seek to get RN's/ NP's/ MD's/ medical/nursing students/LPN's to volunteer as much as possible, but would pay for services when necessary. In addition, it would not take health insurence, but would have very low "cash" prices (say $20.00 for a Dr's appointment). Furthermore, they would accept really low payments for those who needed more extensive services (even $10.00 per month, and they would not report to collection agencies for those who paid even this minimal amount). In a perfect world this clinic would integrate DENTAL services since so many people cannot afford to maintain dental health (using volunteers and dental school students).

Even with the small cash payments, and volunteer services there would still probably be a significant deficit. This could be offset by aggressively seeking direct public, government, charity, foundation, and yes even hospital donations (on the theory that these clinics would reduce pressure that would otherwise be put on ER's). They might even maintain "front" businesses such as thrift stores or restaurents with the profits going to help with clinic expenses (in theory the public would patronize these businesses in part to help a good cause) In this community companies like Eli Lilly alone would probably donate millions to such an effort. They would also seek cheap, or free space from the city, and or private individuals (there are many economically depressed areas of allmost every city with such space). Some would say that these exist right now with the many 24 hour/Emergency clinics. However, these are quite expensive ( I paid $375.00 to have an ingrown toe nail removed last year) and they demand payment in full on the spot (and don't integrate the other elements mentioned above into their operation).

[purplemania, BSN, RN]

You would have a hard time staffing it, as even the Health Dept. has a hard time getting professional staffing since people can earn more elsewhere. Your liability would be the same as someone who charges a lot, and other expenses would be fixed (rent, electricity), unless there was a charity or foundation that subsidized the project. I think energy would be better spent in trying to get basic insurance for everyone. Last year our hospital lost around $40 million that cannot be recouped thru federal agencies, insurance or tax refunds. Just money out the door for people who use the ER and other services free, or nearly free. I think you have a great idea, but I am not sure it is financially plausible.

[not now, RN]

Wouldn't it be hard to find out how much one can actually pay? People lie and cheat to get the most for the least amount of money, I'm not talking people who look for bargins I'm talking those who outright lie to get the most "benefits" from any situation. You don't believe me, come visit my area of the world.

[memphispanda, RN]

I read somewhere that a few docs are going cash only--not necessarily pay what you can though.

Anyway, if you could weed out those would would take advantage (who never have available money, go for every sniffle, etc) then it would be a fine idea. Especially if you allowed payment through service, goods, etc. My father is self-employed and has had people pay him with things like bushels of corn, yard work, house repair, etc. For the most part it has worked really well.

[jemb]

Sounds like a free clinic to me.

[eak16]

I think it boils down to whether you believe that humans are natually good and would use this system responsibly and unselfishly, or naturally evil and would abuse it even more than they do ER's now. I am leaning toward the latter.

[chris_at_lucas_RN, RN]

Roland, don't know if you are aware of it, but Patch Adams MD is a real person, who currently exists and currently runs a free clinic.

His website is something like Gesundheit Institute. You can google "Patch Adams" and find it.

He suggests doing something good for free, in your own back yard. Mother Teresa said the same thing.

You don't need anything fancy to provide services. I realize you are talking about a clinic (and I hate to use this word ) but, have you thought of....

malpractice insurance?

medications?

rent?

equipment?

lab tests?

utilities?

And who will you refer those patients to, whose difficulties are sufficiently profound that you cannot care for them? Trust me, people will know who you are and not answer the phone when you call.

Your idea is laudible. It is one I have thought of as well. I am sure we are not alone.

These clinics exist--if you are serious, check out Patch Adams and then approach your local United Way. They can help guide you and eventually possibly provide funding.

No need to reinvent the wheel--learn how others are already doing this.

[Roland]

In a very real way these clinics already exist, but they are called the ER! Consider, that here in Indianapolis anyone can go to Saint Francis hospital (let alone Wishard which is the local "Medicaid hospital") and they WILL be treated. Futhermore, Saint Francis will then bill them and accept "mostly whatever" they can pay. In my case I went there for a back injury last year and was evaluated for possible "cauda equina" syndrome. I was referred for an MRI also at the hospital. My bill was a whopping $1,300 and since I didn't have health insurence I still pay about $25.00 per month.

My plan deviates in that because it is not "integrated" into the hospital setting, the cost of providing services should be much less. That is because many ER cost reflect fixed, very high capital expenses. What I am proposing is a "stress relief valve" for ER's that would address some of the concerns of our health care system without resorting to a single payer or socialized system.